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Prevalence and Factors Associated with Current Smoking Among High School Adolescents in Karachi, Pakistan

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Prevalence and Factors Associated with Current Smoking Among High School Adolescents in Karachi, Pakistan SOUTHEAST ASIAN J TROP MED PUBLIC HEALTH PREVALENCE AND FACTORS ASSOCIATED WITH CURRENT SMOKING AMONG HIGH SCHOOL ADOLESCENTS IN KARACHI, PAKISTAN Shafquat Rozi1, Saeed Akhtar1, Sajid Ali1 and Javaid Khan2 1Department of Community Health Sciences, 2Department of Medicine, Aga Khan University, Karachi, Pakistan Abstract. Our objective was to estimate the prevalence and evaluate factors associated with smok- ing among high school adolescents in Karachi, Pakistan. A school-based, cross-sectional survey was conducted in three towns in Karachi, namely, Gadap Town, Bin-Qasim Town and Malir Town, from January through May 2003. Two-stage cluster sampling stratified by school type was em- ployed to select schools and students. We recruited and interviewed 772 male students regarding socio-demographic factors, smoking history of students, their families/friends, number of siblings, and place of residence. The prevalence of smoking (30 days) among adolescents was 13.7%. Final multiple logistic regression analysis showed that after adjusting for age, ethnicity, and place of resi- dence, being a student at a government school (OR=1.6; 95%CI: 1.0-2.7), parental smoking (OR=1.7; 95%CI: 1.1-2.8), uncle smoking (OR=1.7; 95%CI: 1.2-2.8), peer smoking (OR=6.2; 95% CI: 3.9- 9.9), and spending leisure time outside home (OR=3.9; 95%CI 1.2-13.2) were significantly associ- ated with adolescent smoking. INTRODUCTION of smoking in the Pakistani population aged 15 years and above (Alam, 1998). According to the Tobacco is the single most important pre- National Health Survey of Pakistan (NHSP) 1998, ventable cause of disease and premature death about 34% of males and 12.5% of females use in the world today. Tobacco causes about three tobacco in different forms (PMRC, 1998). A sur- and a half million deaths throughout the world vey conducted in Islamabad showed that 27% and kills nearly 10,000 people worldwide every of children aged 10-14 years were smokers day (WHO, 2002a). Tobacco is a known cause (Anonymous, 2002). of about 25 diseases and its impact on global disease burden is increasing continuously (WHO, Researches suggest that tobacco use is 2002b). often initiated during adolescence (Sinha et al, 2002). Tobacco affects adolescents in a num- The World Health Organization (WHO) cur- ber of ways. Active smoking by young people is rently estimates that there are 1.1 billion smok- associated with significant health problems. At ers presently in the world (WHO, 2002b). Glo- present, 150 million adolescents use tobacco bally, approximately 47% of males and 12% of worldwide (WHO, 2002c). Approximately 90% females are smokers. In developing countries, of smokers begin smoking before the age of 21 48% of males and 7% of females smoke, years (ALA, 2002). By the age of 11 years one- whereas, in developed countries, 42% of males third of children, and by the16th year, two-thirds and 24% of females smoke (ALA, 2002). Paki- of children have experimented with smoking (Na- stan ranks 10th among tobacco producing coun- tional Statistics, 2000). tries (CDC, 2001). A population-based study during 1990-1994 reported a 21.6% prevalence Factors that commonly play a role in the initiation of smoking among adolescents in- Correspondence: Shafquat Rozi, Division of Epidemi- clude social factors (high levels of social accept- ology and Biostatistics, Department of Community ability, marketing efforts, role modeling by par- Health Sciences, Aga Khan University, Stadium Road, ents and other family members (Avenevoli and PO Box 3500, Karachi-74800, Pakistan. Merikangas, 2003; Komro et al, 2003), peers Tel: +9221-4930051 ext 4918 (Sussman et al, 1990; Zhang et al, 2000), teach- E-mail: [email protected] ers (Poulsen et al, 2002), personal factors (psy- 498 Vol 36 No. 2 March 2005 SMOKING AMONG HIGH SCHOOL ADOLESCENTS chological (Supranowicz, 1998), relaxation, plea- our visit, an average of twenty-five students from sure (Ahmadi et al, 2001), and self confidence each government school and twenty students (Sieminska et al, 2000)), and economic factors from each private school were selected system- [price is recognized as a major determinant of atically on the basis of their seating arrangement. cigarette consumption (Townsend, 1998)]. Data collection As smoking is usually initiated during ado- Written permission was taken from Nazim, lescence, it should be a public health priority to an administrative official in charge of towns, and educate this group regarding the hazards of from a district education officer, to conduct re- smoking, so that their behavior can be modi- search in schools in their region. Three days of fied. Before initiating such awareness programs, training for five data collectors was carried out it is important to understand the factors con- prior to data collection. Training was comprised tributing to adolescent smoking and design ef- of questionnaire and field test explanations. Field fective interventions to prevent it. One of the staff were able to communicate in the local and most important commitments a country can the English language. A field supervisor was re- make for future economic, social, and political sponsible to make spot checks and discuss is- progress and stability is to address the health sues and problems of field sites. Written con- and development needs of its adolescents. sent was also taken from individual school au- Therefore, the objective of this study was to es- thorities for interviewing their school students. timate the prevalence of and identify the factors At each selected school, after explaining the associated with the smoking status of school- purpose of the study, verbal consent was taken going adolescents in Karachi, Pakistan. from the students and a structured questionnaire was administered. The academic schedule of the SUBJECTS AND METHODS students was taken into account and interviews This cross-sectional study was conducted were conducted during recess/lunch time or from January through May 2003 at government during free periods in school hours. and private schools in Karachi, the largest city Questionnaire in Pakistan, with a population of 9.8 million (PCO, The questionnaire included questions on 2000). Karachi has been demarcated into 18 socio-demographic factors, including age, administrative towns with 178 union councils ethnicity, religion, highest level of parental edu- (CDGK, 2003). We selected three towns for our cation, occupation of parents (proxy indicators research study: Gadap Town, Bin-Qasim Town, for socio-economic status), smoking history of and Malir Town. There is an ethnic mix of people family/friends, number of siblings, and place of residing in these three towns. Socio-economi- residence. The smoking behavior of the student cally, the population belongs to the upper, was assessed by asking whether the individual middle, and lower middle classes. The popula- had smoked in his life or not, and the age and tion of these three towns in this survey was there- particular reasons for initiation of smoking. We fore considered to be representative of the popu- also asked about the frequency of smoking. lation of Karachi. Definition of a smoker Selection of schools and subjects The outcome variable smoking status A two-stage cluster sampling with stratifi- (smoker or non-smoker) was assessed based cation based on school type (government or pri- on 30-days prevalence of cigarette smoking (that vate) was employed for the selection of schools is whether or not one had smoked a cigarette in and recruitment of adolescents. We recruited the past 30 days) (Unger et al, 2000; Davis et al, 772 male secondary schoolstudents. In three 2001; Rigotti et al, 2002; Lantz, 2003) and used selected towns, there were 79 registered gov- for analysis. For smokers, current frequency of ernment and private schools (CDGK, 2003). smoking was further categorized as daily, weekly, Each school was treated as a cluster, and 33 of monthly, and occasional smoker. 79 were selected randomly proportionate to the number of types of schools; 17 of them were Statistical analysis government and the rest of them were private Descriptive statistics included means schools. Of the students present on the day of (± standard deviation) for continuous, and pro- Vol 36 No. 2 March 2005 499 SOUTHEAST ASIAN J TROP MED PUBLIC HEALTH portions for categorical variables. To identify the Table 1 factors associated with smoking among school- Socio-demographic characteristics, history of going adolescents, associations between out- smoking in respondents, and their family and come variables (smoker and non-smoker) and friends, living in Karachi, Pakistan. independent variables were sought. Crude odds ratio (OR) and their 95% confidence intervals (CI) Characteristics Frequency Percentage were calculated by univariate logistic regression Type of schools analysis. Variables with p ≤ 0.25 or biologically Government 427 55.3 meaningful were selected for multivariate analy- Private 345 44.7 sis (Hosmer and Lemeshow, 1996). To assess Age of the respondent the independent effect of individual factors, po- <13 102 13.2 13 670 86.8 tential confounders were controlled by means ≥ Average age of respondent (S.E) 14.8 (0.1) of multiple logistic regression analysis and ad- Residential area of respondent justed OR (AOR) with their 95%CI . After the main Gadap Town 203 26.3 effect model, plausible interactions were evalu- Bin Qasim Town 366 47.4 ated for inclusion in the multivariate model. The Malir Town 203 26.3 statistical package Epi-Info version 6 was used Mother tongue of respondent to enter the data, Fox-pro version 6 for data Urdu 159 20.6 Sindhi 306 39.6 cleaning and analysis was performed by using Punjabi 54 7 SPSS version 10. Balochi 189 24.5 Others 64 8.3 RESULTS aFamily and friends history of smoking Parent smokes 244 31.6 Table 1 gives the demographic character- Brother smokes 61 7.9 istics of the respondents.
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