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Cigarette Use and Risky Behaviors Among Private, High School Students in La Paz, Bolivia

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Cigarette Use and Risky Behaviors Among Private, High School Students in La Paz, Bolivia Investigación original / Original research Teens in trouble: cigarette use and risky behaviors among private, high school students in La Paz, Bolivia Kirk A. Dearden,1 Benjamin T. Crookston,2 Natalie G. De La Cruz,3 Gordon B. Lindsay,4 Ali Bowden,4 Liz Carlston,4 and Paul Gardner 4 Suggested citation Dearden KA, Crookston BT, De La Cruz NG, Lindsay GB, Bowden A, Carlston L, et al. Teens in trou- ble: cigarette use and risky behaviors among private, high school students in La Paz, Bolivia. Rev Panam Salud Publica. 2007;22(3):160–8. ABSTRACT Objective. To describe the prevalence of cigarette smoking and to identify risky behaviors as- sociated with smoking among adolescents attending high schools in a district of La Paz, Bolivia. Methods. The Youth Risk Behavior Survey was administered to a sample of 394 males and 182 females, from 13–18 years of age, at six, randomly-selected schools in District II of La Paz. Frequencies, chi-square tests, and logistic regression were employed to identify factors associ- ated with cigarette use during the 30 days prior to the survey. Results. Approximately 40% of the sample (39.4% of males and 33.7% of females) had smoked cigarettes in the 30 days prior to interview. For both males and females, consumption of alcohol was the single greatest risk factor associated with cigarette use. The males and fe- males who reported consuming at least one alcoholic beverage on three or more occasions in the previous 30 days were 22.3 and 58.5 times (95% CIs: 6.7, 74.1 and 6.8, 502.6, respectively) more likely to smoke tobacco than those who reported no alcohol consumption. Additional risk factors included having participated in a physical fight, having carried a weapon, having had sexual intercourse, and having used illicit drugs during the previous 30 days. Conclusions. Because teenagers who smoke are also likely to engage in a variety of other risky behaviors, parents, school administrators, and health educators may wish to use smoking to identify at-risk individuals. Among Bolivian teenagers, interventions should focus on pre- venting cigarette use and associated risk behaviors. Key words Adolescent, adolescent behavior, smoking, risk-taking, Bolivia. Smoking is one of the most impor- the World Health Organization (WHO) 1 Boston University School of Public Health, Depart- ment of International Health, Boston, Massachu- tant contributors to many forms of as the second leading cause of mortal- setts, United States of America (USA). Send cor- cancer, heart disease, respiratory dis- ity worldwide (1). Each year approxi- respondence to: Kirk Dearden, DrPH, MPH, orders, and other noncommunicable mately 5 million deaths are attributed Associate Professor, Department of International Health and Center for International Health and diseases, and has been identified by to cigarette smoking, and if present Development, Boston University School of Public smoking patterns remain unchanged, Health, 85 East Concord Street, Boston, Massachu- setts, 02118-2526, USA; telephone: 01-617 414-1451; 3 University of Alabama at Birmingham School of the number of annual tobacco-related fax: 01- 617 414-1261. Public Health, Department of Health Behavior, deaths is expected to double by 2010. 2 University of Utah School of Medicine, Depart- Birmingham, Alabama, USA. ment of Family and Preventive Medicine, Salt 4 Brigham Young University, Department of Health Seventy percent of such deaths will Lake City, Utah, USA. Science, Provo, Utah, USA. occur in developing countries (1). In 160 Rev Panam Salud Publica/Pan Am J Public Health 22(3), 2007 Dearden et al. • Cigarette use and risky behaviors among teens in La Paz, Bolivia Original research the Western Hemisphere alone, one- Peru, and Venezuela) had the second centages have most likely increased in third of all heart disease and cancers highest smoking rates among teen- recent years since 28% of those who can be attributed to cigarette use (2). agers. In addition, in parts of the An- were nonsmokers in 2000 reported that Despite the efforts by the Pan Ameri- dean and Southern Cone areas, one in they planned to start smoking within can Health Organization (PAHO), four nonsmoking respondents re- the next year. In contrast, 64.7% of cur- ministries of health, and various non- ported an intention to start smoking rent smokers reported that they would profit organizations to curb the to- soon (8). Such rates of cigarette use like to quit, with 66.9% reporting an un- bacco epidemic in the Americas, and smoking intentions portend an in- successful attempt to do so in the year smoking prevalence in many countries crease in the prevalence of chronic dis- preceding the survey. Of teens sur- in the Region has remained relatively eases, as well as poor health, economic veyed, nearly 20% felt that, in general, unchanged over the past decade, and outcomes, and mortality. smokers had more friends; 40% were no country has fully implemented In addition to the negative, direct being exposed to second-hand smoke in policies to decrease smoking among consequences of cigarette smoking, re- their homes; 88% were aware of tobacco its population (2). search shows that teenage smokers advertising on local billboards; and 82% Adolescence has been identified as a often engage in other risky behaviors were able to purchase tobacco despite “crucial life stage for preventing to- that contribute to poor health (3, 9–12). being underage (8). Monitoring the bacco use and its consequences” be- Tobacco is referred to as a “gateway prevalence of smoking and other risky cause this is when most individuals drug” because teens who smoke will behaviors among teens is imperative initiate smoking (3). In the United often experiment with other drugs because it allows researchers to recog- States of America (U.S.), for example, thereafter (3, 13–15). In addition, teen nize potential associations between 50% of current smokers started smok- smoking has been linked to the early these behaviors and to plan and imple- ing before they reached 14 years of initiation of sexual activity and multi- ment appropriate health interventions age; 90% had started before they ple sexual partners (16), delinquency, for this high-risk population. The pur- turned 19 (4). Likewise, a global, cross- poor academic performance, and vio- pose of this article is to determine the country comparison of cigarette use lence (10). Jocelyn Elders, former U.S. prevalence of cigarette smoking among revealed that among smokers 13–15 Surgeon General, stated: a group of private high school students years of age, 23% had begun before 10 from 13 to 18 years of age in La Paz, Bo- years of age (5). Due in part to the ad- When a young person starts to livia, and to identify risk factors and be- dictive nature of nicotine, individuals smoke or use tobacco, it is a signal, haviors associated with cigarette use. who begin smoking at a young age are an alarm that he or she may get in- We also highlight programmatic impli- more likely to become regular and/or volved in other risky behaviors. This cations and provide suggestions for fur- heavy smokers and to get sick or die is one of the few early warning signs ther research. from smoking-attributable causes (6). we have in public health. If we can As such, smoking prevention and ces- prevent tobacco use in the first sation interventions directed towards place, we might have a big impact MATERIALS AND METHODS youth must remain a public health pri- on preventing or delaying a host of ority, especially in countries where a other destructive behaviors among This study is part of a larger re- considerable percentage of youth our young people (17). search project investigating risky be- smoke. haviors among teens in Bolivia, the The rate of smoking in the Region of Understanding and addressing the Philippines, and the Ukraine. The the Americas is the third highest in the relationships between cigarette smok- methods for the umbrella project are world, behind Europe and the West- ing and other behaviors is critical to described in more detail elsewhere ern Pacific (7). Within the Americas, protecting the health of adolescents and (19). A summary of the methods used rates of teenage smoking, particularly to improving the health outcomes of the for the present study follows. in Latin America, remain worthy of whole population. Youth constitute a concern. The Global Youth Tobacco large portion of Bolivia’s population— Survey (GYTS), 1999–2001, revealed 40% of the total population is under 15 Instrument that in more than half of the sites sur- years of age (18). Given the high rates of veyed in the Americas, at least 20% of smoking among youth in the Andean The Youth Risk Behavior Surveil- adolescents from 13 to 15 years of age region, a better understanding of the lance Survey (YRBSS) was developed currently smoke (8). The Southern risk factors and behaviors associated in 1990 by the U.S. Centers for Disease Cone countries (Argentina, Chile, with smoking in Bolivia is timely. The Control and Prevention (CDC) for the Paraguay, and Uruguay) showed the 2000 GYTS in La Paz revealed that purpose of analyzing and monitoring greatest proportion of teenage smok- nearly one in three (31.3%) adolescents trends related to six priority areas of ers, with 40% of Chilean teens report- from 13 to 15 year of age were current risk behavior among high school ing regular cigarette use. The Andean smokers. More than 10% began smok- youth (from 13 to18 years of age) (20, area (Bolivia, Columbia, Ecuador, ing before 10 years of age. These per- 21). Priority areas for the YRBSS are: Rev Panam Salud Publica/Pan Am J Public Health 22(3), 2007 161 Original research Dearden et al.
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