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OBJECTIVE: To determine the prevalence and determinants of cigarette smoking among intermediate (junior secondary) schoolboys in Riyadh, Saudi Arabia. PARTICIPANTS: A sample of 1382 students (ages 12-19 years) in 45 classes randomly selected from 15 schools, using a two- stage stratified cluster sampling scheme. DESIGN: Students in the selected classes were requested to complete an anonymous questionnaire, under the supervision of trained interviewers. Univariate and multivariate statistical analyses of potential risk factors were performed. SETTING: Intermediate schools in Riyadh, Saudi Arabia. MAIN OUTCOME MEASURES: Association between current smoking and socio- demographic variables, history of smoking, age of smoking initiation, smoking behaviour among family members, knowledge of the harmful effects of smoking, and whether smoking is allowed in the presence of relatives and acquaintances. RESULTS: The prevalence of current smokers was 13.2% overall, ranging from 3.2% in those 12-13 years old to 31.1% in those aged 18-19. Some of the variables (nationality, father's education, and smoking allowed in the presence of parents or teachers) found to be associated with current smoking in a univariate analysis were no longer significantly associated with smoking in the multivariate analysis. By multivariate analysis, knowledge of the harmful effects of smoking, age, smoking allowed in the presence of friends or brothers, and previous smoking were statistically significant determinants of current smoking. CONCLUSIONS: Current health education activities against smoking should be continued and extended to the young population to further reduce the prevalence of smoking and its health consequences. Religious antipathy toward smoking should be emphasised in any local anti-smoking campaigns. 




OBJECTIVE:

To identify the predictors that lead to cigarette smoking among high school students by utilizing the global youth tobacco survey in Riyadh, Kingdom of Saudi Arabia (KSA).

METHODS:

A cross-sectional study was conducted among high school students (grades 10–12) in Riyadh, KSA, between April 24, 2010, and June 16, 2010.

RESULTS:

The response rate of the students was 92.17%. The percentage of high school students who had previously smoked cigarettes, even just 1–2 puffs, was 43.3% overall. This behavior was more common among male students (56.4%) than females (31.3%). The prevalence of students who reported that they are currently smoking at least one cigarette in the past 30 days was 19.5% (31.3% and 8.9% for males and females, respectively). “Ever smoked” status was associated with male gender (OR = 2.88, confidence interval [CI]: 2.28–3.63), parent smoking (OR = 1.70, CI: 1.25–2.30) or other member of the household smoking (OR = 2.11, CI: 1.59–2.81) who smoked, closest friends who smoked (OR = 8.17, CI: 5.56–12.00), and lack of refusal to sell cigarettes (OR = 5.68, CI: 2.09–15.48).

CONCLUSION:

Several predictors of cigarette smoking among high school students were identified.

Background

Most of the studies investigating the prevalence of asthma in various countries have focused on children below the age of 15 years or adults above the age of 18 years. There is limited knowledge concerning the prevalence of asthma in 16- to 18-year-old adolescents. Our objective was to study the prevalence of asthma and associated symptoms in 16- to 18-year-old adolescents in Saudi Arabia.

Methods

A cross-sectional study was conducted in secondary (high) schools in the city of Riyadh utilizing the International Study of Asthma and Allergies in Children (ISAAC) questionnaire tool.

Results

Out of 3073 students (1504 boys and 1569 girls), the prevalence of lifetime wheeze, wheeze during the past 12 months and physician-diagnosed asthma was 25.3%, 18.5% and 19.6%, respectively. The prevalence of exercise-induced wheezing and night coughing in the past 12 months was 20.2% and 25.7%, respectively. The prevalence of rhinitis symptoms in students with lifetime wheeze, physician-diagnosed asthma and exercise-induced wheeze was 61.1%, 59.9% and 57.4%, respectively. Rhinitis symptoms were significantly associated with lifetime wheeze (OR = 2.5, p value < 0.001), physician-diagnosed asthma (OR = 2.2, p < 0.001), and exercise-induced wheeze (OR = 1.9, p value < 0.001).

Conclusions

The prevalence of asthma and associated symptoms in 16- to 18-year-old adolescents in Saudi Arabia is high, although it is within range of reported prevalence rates from various parts of the world.

Objective:

To estimate the prevalence of smoking among secondary school students in National Guard area of Riyadh, and explore the reasons for the smoking and the attitude of non-smoker toward smoking habit.

Design:

A cross-sectional study was conducted in June 2009. By random sampling technique 255 students were enrolled from secondary school of National Guard area, Riyadh, Saudi Arabia. A self-administered questionnaire was used for data collection.

Results:

Current smokers represented 28.6% of the students. The most common reasons for smoking were: having free time (81.6%), for the relief of stress (63.2%) and seeing some of their teachers smoking (61.8%).

Most of the smokers started the habit before the age of 15 years old (89%). 84% of non-smokers suggested to ban smoking in public places. 42.2% of students were planning to start smoking in future.

Religion was the most important reason for not smoking among non smokers.

Conclusion:

The prevalence of smoking is big enough a problem to be considered as a warning for an impending epidemic Health education provision should have a greater role in schools Governmental commitment and social support are vital if health education and awareness and especially quit smoking programs are to be implemented and sustained.

Background

College students are vulnerable to tobacco addiction. Tobacco industries often target college students for marketing. Studies about prevalence of tobacco use and its correlates among college students in Nepal are lacking.

Methods

A cross-sectional survey was carried out in two cities of western Nepal during January-March, 2007. A pre-tested, anonymous, self-administered questionnaire (in Nepali) adapted from Global Youth Tobacco Survey (GYTS) and a World Bank study was administered to a representative sample of 1600 students selected from 13 junior colleges by two-stage stratified random sampling.

Results

Overall prevalence of 'ever users' of tobacco products was 13.9%. Prevalence among boys and girls was 20.5% and 2.9% respectively. Prevalence of 'current users' was 10.2% (cigarette smoking: 9.4%, smokeless products: 6.5%, and both forms: 5.7%). Median age at initiation of cigarette smoking and chewable tobacco was 16 and 15 years respectively. Among the current cigarette smokers, 58.7% (88/150) were smoking at least one cigarette per day. Most (67.8%) 'Current users' purchased tobacco products by themselves from stores or got them from friends. Most of them (66.7%) smoked in tea stalls or restaurants followed by other public places (13.2%). The average daily expenditure was 20 Nepalese rupees (~0.3 USD) and most (59%) students reported of having adequate money to buy tobacco products. Majority (82%) of the students were exposed to tobacco advertisements through magazines/newspapers, and advertising hoardings during a period of 30 days prior to survey. The correlates of tobacco use were: age, gender, household asset score and knowledge about health risks, family members, teachers and friends using tobacco products, and purchasing tobacco products for family members.

Conclusion

School/college-based interventions like counseling to promote cessation among current users and tobacco education to prevent initiation are necessary. Enforcement of legislations to decrease availability, accessibility and affordability of tobacco products and policies to change social norms of tobacco use among parents and teachers are necessary to curb the tobacco use among college students.

Cigarette smoking behaviour among the young was examined in the light of the responses of over 78 000 students to a 1972 questionnaire survey of Canadian schools. As few as 2% (8-year-old girls) and as many as 60% (16 year--old boys) were smoking one or more cigarettes per week. The prevalence of smoking was higher than that reported in earlier studies. Students, particularly girls, were beginning to smoke at progressively earlier ages. Some differences in smoking behaviour were found between regions, language groups and groups of children whose parents did or did not smoke. Recognition of immediate rather than long-term effects of smoking on health was reported as an important consideration in not smoking.

Objectives

As part of efforts to develop a smoking control strategy for Japanese adolescents, the results of two nationwide surveys on adolescent smoking behaviour were compared.

Design

Descriptive study on smoking behaviour among high school students was conducted. Self‐reporting anonymous questionnaires were administered to 115 814 students in 1996 and 106 297 in 2000 through randomly sampled junior and senior high schools throughout Japan.

Main outcome measures

Smoking prevalence, proportion of smokers by usual sources of cigarettes, national estimated cigarettes consumed by minors, share of cigarette brands smoked by high school students.

Results

The experiment rate among junior high school boys decreased in 2000 compared with that in 1996, whereas current and daily smoking rates did not. Although prevalence among Japanese girls was much lower than that among boys, prevalence among girls increased in 2000. The main source of cigarettes among high school smokers was vending machines. The proportion of smokers who usually purchased cigarettes from vending machines increased in 2000, in spite of the 1998 introduction of restrictions on night‐time operations. Japanese adolescents were more likely than adults to smoke American cigarette brands, and the adolescent market share of American brands has increased rapidly, especially for menthol brands.

Conclusions

This survey revealed the seriousness of the problem of smoking behaviour among Japanese high school students, and suggested that this behaviour may be influenced by social environmental factors, including the marketing strategies of the tobacco industry. Action should be taken to reduce the prevalence and impact of pro‐tobacco marketing messages and to abolish cigarette vending machines.

OBJECTIVE: To measure the smoking behaviour and attitudes among Saudi adults residing in Riyadh City, the capital of the Kingdom of Saudi Arabia. DESIGN: Cross-sectional survey. SETTING AND SUBJECTS: Primary health care centres (PHCCs) in Riyadh City were selected by stratified random sampling. Subjects resident in each PHCC catchment area were selected by systematic sampling from their records in the PHCCs; 1534 adults aged 15 years and older were interviewed during January to April 1994. MAIN OUTCOME MEASURES: Self-reported smoking prevalence; age of smoking initiation; daily cigarette consumption; duration of smoking; reasons for smoking, not smoking, and quitting smoking; intentions to smoke in the future; and attitudes toward various tobacco control measures. RESULTS: 25.3% of respondents were current smokers, 10.2% were ex-smokers, and 64.5% had never smoked. About 79% of all smokers started smoking between the ages of 15 and 30 years, and 19.5% before age 15. Significantly higher smoking prevalence and daily cigarette consumption were associated with being male, single, and being more highly educated. Relief of psychological tension, boredom, and imitating others were the most important reasons for smoking, whereas health and religious considerations were the most important reasons for not smoking among never-smokers, for quitting among ex-smokers, and for attempting to quit or thinking about quitting among current smokers. About 90% of all subjects thought that they would not smoke in the future. Physicians and religious men were identified as the most effective anti-smoking advocates by a much higher proportion of respondents (44%) than nurses, health educators, and teachers (each less than 5%). Health and religious education were generally cited as more effective in deterring smoking than tobacco control laws and policies. CONCLUSIONS: Cigarette smoking is prevalent among Saudi adults in Riyadh, particularly males, most of whom begin to smoke rather early in life and continue for many years. Health and religious education should be the cornerstone for any organised tobacco control activities, which are urgently needed to combat the expected future epidemic of smoking-related health problems. 






Background

We examined the associations between substance use (cigarette smoking, alcohol drinking, and cannabis use) and psychosocial characteristics at the individual and family levels among adolescents of the Seychelles, a rapidly developing small island state in the African region.

Methods

A school survey was conducted in a representative sample of 1432 students aged 11-17 years from all secondary schools. Data came from a self-administered anonymous questionnaire conducted along a standard methodology (Global School-based Health Survey, GSHS). Risk behaviors and psychosocial characteristics were dichotomized. Association analyses were adjusted for a possible classroom effect.

Results

The prevalence of cigarette smoking, alcohol drinking and cannabis use was higher in boys than in girls and increased with age. Age-adjusted and multivariate analyses showed that several individual level characteristics (e.g. suicidal ideation and truancy) and family level characteristics (e.g. poor parental monitoring) were associated with substance use among students.

Conclusions

Our results suggest that health promotion programs should simultaneously address multiple risk behaviors and take into account a wide range of psychosocial characteristics of the students at the individual and family levels.

BACKGROUND:

Tobacco consumption is associated with considerable negative impact on health. Health professionals, including future doctors, should have a leading role in combating smoking in the community.

OBJECTIVES:

The aims of the study were to assess the prevalence of smoking among medical students of newly established medical colleges in Riyadh city, the capital of Saudi Arabia, as well as to assess students' attitude, practice and their knowledge on the risk factors of tobacco consumption.

METHODS:

A cross-sectional, questionnaire-based study of students from two medical colleges in Riyadh, Saudi Arabia was carried out. The questionnaire used was anonymous, self-administered and developed mainly from Global Adult Tobacco Survey (GATS).

RESULTS:

A total of 215 students participated in this study. Forty students (19%) indicated that they smoke tobacco at the time of the study. All of them were males, which raise the prevalence among male students to 24%. Tobacco smoking was practiced by males more than females (P value <0.0001) and by senior more than junior students (<0.0001). About 94% of the study sample indicated that smoking could cause serious illnesses. About 90% of the students indicated that they would advice their patients to quit smoking in the future and 88% thought that smoking should be banned in public areas. Forty-four students (20%) thought that smoking has some beneficial effects, mainly as a coping strategy for stress alleviation.

CONCLUSION:

Despite good knowledge about the hazards of tobacco consumption, about 25% of the medical students in this study continue to smoke. The main reported reasons should be addressed urgently by policy-makers. Special efforts should be taken to educate medical students on the effective strategies in managing stress during their study as they thought that tobacco smoking could be used as a coping strategy to face such a stress.

A structural equations model examined the influence of three cultural variables of ethnic pride, traditional family values and acculturation, along with the mediating variables of avoidance self-efficacy and perceptions of the “benefits” of cigarette smoking, on cigarette and alcohol use in a sample of Latino middle school students in the Southwest. Girls (N = 585) and boys (N = 360) were analyzed separately. In both groups, higher ethnic pride and traditional family values exerted indirect effects on less cigarette smoking and alcohol use when mediated through greater self-efficacy and less endorsement of the “benefits” of cigarette smoking. Among the girls, greater ethnic pride also had a direct effect on less cigarette and alcohol use. Also, greater acculturation directly predicted more cigarette and alcohol use among the girls, but not among the boys. However, differences between the boys and girls were generally nonsignificant as revealed by multiple group latent variable models. These results offer implications for incorporating cultural variables into the design of culturally relevant prevention interventions that discourage cigarette and alcohol use among Latino adolescents.

Objectives:

To determine the prevalence of symptoms of depression, anxiety and stress among secondary school girls.

Methods:

A cross- sectional study was carried out on secondary school girls in Abha city, Aseer Region, Saudi Arabia, using the Arabic version of the Depression, Anxiety, and Stress Scale (DASS-42).

Results:

Of 545 female students recruited in this study, 73.4% had the symptoms of at least one of the three studied disorders; 50.1% had at least two disorders. The prevalence of symptoms of depression, anxiety and stress was 41.5 %, 66.2% and 52.5% respectively. The majority of symptoms were mild to moderate in severity. The scores for depression, anxiety, and stress were positively and significantly correlated. No significant association was found between the girls’ sociodemographic characteristics and the scores of the three studied disorders.

Conclusion:

One of the most important aspects of a primary care physician’s care of females is to screen for and treat common mental disorders.

The relationship between respiratory symptoms and smoking habits, according to sex, was studied in 2266 teenagers attending secondary school in Paris. Among smokers, the prevalence of usual cough or phlegm, or both, was higher in girls than in boys, whereas such was not the case among non-smokers. That prevalence, as well as the proportion of people with wheezing, were more closely associated with the total number of cigarettes ever smoked by girls than by boys. Moreover, there was a weak but significant association between the total number of cigarettes smoked and respiratory function--FEV1/Ht3 in girls only.

The smoking habits of 9,276 high-school students (15–18 years old) in six cities of Northern Greece were studied using a questionnaire in order to determine the prevalence and possible risk factors for initiation of smoking. We observed that 29.6% of high-school students (32.6% of boys and 26.7% of girls) were current smokers. A percentage of 43.3% had started smoking before the age of 14. Reactive behaviour towards parents’ and teachers’ advice (40.2%) and the existence of smoking friends (40.1%) were the main reasons of initiation. A well-planned integrated anti-smoking campaign is urgently required, especially among students and teachers.

This paper reports the findings of a survey of smoking habits among secondary schoolchildren and medical students in Lagos, Nigeria. Altogether 40% of boys and 8.4% of girls at secondary school, and 72.4% of men and 22.2% of women at medical school were found to smoke. While the smoking habit of the secondary schoolboys was influenced by the smoking habits of their parents and friends, the smoking habit of the secondary schoolgirls and female medical students was mainly influenced by that of their friends. This study provides a baseline against which future studies on smoking habits in developing African countries may be measured, and the results show that health education on cigarette smoking must start in primary and secondary schools.

Background

Many adult cigarette smokers initiated the habit as adolescents. Adolescent tobacco use may be a marker of other unhealthy behaviours. There are limited data on the prevalence and correlates of cigarette smoking among in-school adolescents in Iraq. We aimed to estimate the prevalence of, and assess the socio-demographic correlates of current cigarette smoking among in-school adolescents in Kurdistan region of Iraq.

Methods

Secondary data analysis of the Global Youth Tobacco Survey, conducted in the region of Kurdistan, Iraq in 2006. Logistic regression analysis was conducted to assess the association between current cigarette smoking and explanatory variables.

Results

One thousand nine hundred eighty-nine adolescents participated in the Kurdistan-Iraq Global Youth Tobacco Survey. Of these, 58.1% and 41.9% were boys and girls respectively. The overall prevalence of current cigarette smoking was 15.3%; 25.1% and 2.7% in boys and girls respectively. The factors associated with adolescent smoking were: parents' smoking, smoking in closest friends, male gender, having pocket money and perceptions that boys or girls who smoked were attractive.

Conclusion

We suggest that public health interventions aimed to curb adolescent cigarette smoking should be designed, implemented and evaluated with due recognition to the factors that are associated with the habit.

Risk factors for the uptake of cigarette smoking were examined prospectively in 2159 non-smoking secondary schoolchildren aged 11-13 who participated in a survey in 1983 and were followed up 30 months later, by which time 35 per cent had taken up smoking. In a multivariate logistic model, the strongest predictors to emerge were prior experimentation with cigarettes and sex, with more girls (41%) than boys (30%) starting to smoke. Other predictors of taking up smoking were being uncertain about smoking in the future, reporting having been drunk, having a boy or girl friend, believing teachers and friends would not mind if they took up smoking, and giving lower estimates of prevalence of smoking among teachers. Parental smoking behaviour and attitudes, beliefs about the effects of smoking on health, opinions about smoking and perceived strictness of parents did not predict take up of smoking when other variables were controlled for. The odds of taking up smoking varied from 0.24 (risk = 0.19) for a child with the most favourable combination of risk factors to 3.49 (risk = 0.78) for a child with the worst prognosis. These results differ from those of many cross sectional studies and hence indicate the importance of a prospective approach to this type of research.

Introduction

Recent reports show a sharp increase in smoking rates among girls. We describe prevalence of cigarette smoking and susceptibility to cigarette smoking among female students aged 13 to 15 years in Vietnam and examine the associated factors.

Methods

We used data from female secondary school students aged 13 to 15 years (grades 8-10) from the 2007 Global Youth Tobacco Survey that was conducted in 9 provinces in Vietnam. We used multivariate logistic regression analysis to determine associations between independent variables with smoking status and susceptibility to smoking.

Results

Prevalence of cigarette smoking among girls was 1.2% (95% confidence interval [CI], 0.9-1.5), and 1.5% (95% CI, 1.2-1.9) of girls were susceptible to smoking. Having friends who smoke was the strongest predictor of both smoking status and susceptibility to smoking. Attendance at school classes that described the harmful effects of smoking had significant effects in reducing cigarette smoking. Girls who were exposed to billboard cigarette advertising were more likely to be susceptible to smoking than were those who had not seen advertisements.

Conclusion

Our findings highlight the need for pursuing school-based intervention programs in Vietnam and for countering tobacco advertising and marketing practices that target young women.

Background/Aim:

The aim of the study was to investigate gender differences in obesity and related behavior among adolescent school boys and girls in southwestern Saudi Arabia.

Patients and Methods:

A cross-sectional study on a stratified sample of 1,249 adolescent boys and 620 adolescent girls, was conducted in southwestern Saudi Arabia. They were interviewed and examined for weight and height using standardized techniques.

Results:

The prevalence of obesity and overweight in the present study amounted to 23.2% among boys and 29.4% among girls. The following significant risk factors were identified; being a female [adjusted odds ratio (aOR) =1.372, 95% confidence interval (CI) =1.099-1.753] and lack of class physical exercise (aOR =1.452, 95% CI =1.149-2.117).

Conclusion:

Obesity among adolescents is a public health problem in Southwestern Saudi Arabia. The problem is more prevalent among girls. Thus, there is a need for a national programme in the country to prevent and control obesity among adolescents.

BACKGROUND AND OBJECTIVES:

Adolescence is characterized by rapid physiological, social and cognititive changes. Aim of the present work is to study mental health of Saudi adolescent secondary school girls in Abha city, Aseer region, Saudi Arabia.

METHODS:

A cross-sectional study was conducted in 10 secondary schools for girls using the Arabic version of the symptom-revised checklist 90 (SCL 90-R), a mental health questionnaire that was administered to the girls by fourth-year female medical students.

RESULTS:

The most prevalent mental symptoms in the 545 female students were phobic anxiety (16.4%), psychoticism (14.8%), anxiety (14.3%), and somatization (14.2%). The prevalence of depression, paranoid ideation and interpersonal sensitivity amounted to 13.9%, 13.8% and 13.8%, respectively. The least prevalent mental symptoms were hostility (12.8%) and obsessive-compulsive behavior (12.3%). Overall, psychological symptoms (in terms of a positive global severity index) were found in 16.3% of the girls. In a multivariate logistic regression analysis, no significant relationship was found with sociodemographic factors.

CONCLUSION:

Psychological symptoms and disorders are prevalent in secondary school girls and health professionals need to be able to recognize, manage and follow-up mental health problems in young people. Further research is needed to explore the magnitude of the problem at the national level.

Background

Subjective health complaints are common among adolescents. There is evidence that girls are more likely to register complaints than boys. This study examines gender differences in the relationship between daily smoking and recurrent subjective health complaints in school-age adolescents in the United States.

Methods

A cross-sectional design with a multistage probability sample was used to survey 13,339 middle and high school students (grades six through 10) with the US 2001-2002 Health Behavior in School-Aged Children Survey (HBSC).

Results

Recurrent subjective health complaints were higher for adolescents who smoke daily and experiment with cigarettes than for those who never smoke. In logistic regression analyses, the odds of daily smoking increased two-fold for both boys and girls who report recurrent irritability/bad temper. For girls, the odds of daily smoking were higher among those who reported recurrent headache, stomachache, and backache compared to never smokers. For boys only recurrent backache and feeling dizzy were associated with increased odds of daily smoking.

Conclusions

The relationship between recurrent subjective health complaints and daily smoking provides new insights into both conditions for school-age adolescents. Findings from this study suggest different patterns of association between daily smoking and recurrent subjective health complaints occur for girls and boys. Further studies are needed to explore causes and treatment of daily smoking and recurrent health complaints among school-aged children.

In the MRC/Derbyshire Smoking Study a cohort of about 6000 adolescents was surveyed annually from 1974 when they entered secondary school aged 11-12 years until 1978 when they reached 15-16 years. In 1981 after the adolescents had left school they were again surveyed by post. Each year from 1974 to 1978 and again in 1981 they answered a questionnaire on their smoking behaviour and other issues. Information on the schools attended by these adolescents was obtained from their teachers and headteachers. This paper examines the relation between the school environment and the adolescents' smoking behaviour both before and after leaving school. The prevalence of smoking was higher among those boys who attended schools that were single sex, non-denominational, or had a parent-teacher association, no health education, no female teachers, or whose headteacher smoked cigarettes. Among girls the prevalence of smoking was higher if they attended a school that had optional school uniform and no health or antismoking education. The importance of these findings for the development of effective preventive measures is discussed.

Background

Diverse psychosocial factors have been associated with the use of cigarettes by adolescents. We investigated gender differences in tobacco smoking, and factors correlated with smoking among boys and girls.

Methods

Data was collected on recent cigarette smoking (CS) and related factors, with a focus on religious beliefs, leisure activities, family structure, relationships and parental monitoring from 2,691 private school-attending youths from 28 schools in São Paulo, Brazil, selected via probability sampling. Estimates were derived via weighted hierarchical logistic regression models.

Results

There was no difference in the prevalence of recent cigarette smoking between boys and girls (14.2%). Older age (aORboys = 1.71[1.33-2.21]; aORgirls = 1.73[1.35-2.23]), second-hand smoke exposure at home (aORboys = 1.52[1.00-2.29]; aORgirls = 1.74[1.13-2.68]) and not having a religion (aORboys = 1.99[1.41-2.81]; aORgirls = 1.78[1.14-2.78]) were associated with CS in boys and girls. Adolescents who went out often at night were more likely to be tobacco smokers (aORboys = 8.82[3.96-19.67]; aORgirls = 14.20[6.64-30.37]). For girls, data suggest that CS was also associated with a lack of parental attention and care (aORgirls = 4.37[1.19-16.04]) and no participation in youth religious activities (aORgirls = 2.76[1.49-5.12]). For boys, CS was additionally associated with the loss of one or both parents (aORboys = 3.75[1.78-7.85]).

Conclusions

Although older age, living with smokers at home and lack of religion were common contributing factors to cigarette smoking among all adolescents, girls were influenced to a greater degree by family relationships and religiosity than boys. The study results may be materially important to the development of prevention programs that influence determinants connected to gender and the implementation of single-core models of prevention; gender differences must be considered in order to reduce adolescent CS.

Background

Smoking, alcohol drinking and cannabis use ("risk behaviors") are often initiated at a young age but few epidemiological studies have assessed their joined prevalence in children in developing countries. This study aims at examining the joint prevalence of these behaviors in adolescents in the Seychelles, a rapidly developing country in the Indian Ocean.

Methods

Cross-sectional survey in a representative sample of secondary school students using an anonymous self-administered questionnaire (Global Youth Tobacco Survey). The questionnaire was completed by 1,321 (92%) of 1,442 eligible students aged 11 to 17 years. Main variables of interest included smoking cigarettes on ≥1 day in the past 30 days; drinking any alcohol beverage on ≥1 day in the past 30 days and using cannabis at least once in the past 12 months.

Results

In boys and girls, respectively, prevalence (95% CI) was 30% (26–34)/21% (18–25) for smoking, 49% (45–54)/48% (43–52) for drinking, and 17% (15–20)/8% (6–10) for cannabis use. The prevalence of all these behaviors increased with age. Smokers were two times more likely than non-smokers to drink and nine times more likely to use cannabis. Drinkers were three times more likely than non-drinkers to smoke or to use cannabis. Comparison of observed versus expected frequencies of combination categories demonstrated clustering of these risk behaviors in students (P < 0.001).

Conclusion

Smoking, drinking and cannabis use were common and clustered among adolescents of a rapidly developing country. These findings stress the need for early and integrated prevention programs.

Objective: To determine whether adolescent smoking behaviour is associated with their perceived exposure to teachers or other pupils smoking at school, after adjustment for exposure to smoking at home, in school, and best friends smoking.

Design: Logistic regression analysis of cross sectional data from students in Denmark.

Subjects: 1515 grade 9 students (mean age 15.8) from 90 classes in 48 Danish schools.

Outcome measure: Self reported smoking behaviour; daily smoking and heavy smoking, defined as those smoking more than 20 cigarettes per week.

Results: Of the students in this study, 62% of boys and 60% of girls reported being exposed to teachers smoking outdoors on the school premises. The proportion of boys and girls reporting to have been exposed to teachers smoking inside the school building were 86% and 88%, respectively. Furthermore, 91% of boys and 92% of girls reported that they had seen other students smoking outdoors on the school premises. Adolescents' perceived exposure to teachers smoking outdoors on the school premises was significantly associated with daily smoking, having adjusted for sex, exposure to teachers smoking indoors at school and pupils smoking outdoors at school, as well as the smoking behaviour of mother, father, and best friend (odds ratio (OR) 1.8, 95% confidence interval 1.2 to 2.8). Adolescents' perceived exposure to teachers smoking inside the school building was not associated with daily smoking (OR 0.9, 95% CI 0.5 to 1.6) and perceived exposure to pupils smoking outdoors was not associated with daily smoking (adjusted OR 1.5, 95% CI 0.5 to 4.4). There were similar findings with heavy smoking as the outcome variable.

Conclusions: Teachers smoking during school hours is associated with adolescent smoking. This finding has implications for future tobacco prevention strategies in schools in many countries with liberal smoking policies where it might provide support for those working to establish smokefree schools.