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Original Research Article Prevalence of Smoking Among the High School Original Research Article Prevalence of Smoking among the High School Students in Thimphu,Bhutan ABSTRACT Due to increasing pace of modernisation, smoking is common among the youth today. It is also a major public health problem worldwide. Smoking is the most important cause of preventable death. Moreover it gives various socio-economic burdens to the society. Despite strict surveillance and smoking control act in Bhutan, youth are increasingly found smoking. Having said that, very limited studies have been conducted in Bhutan, particularly focussing on the smoking by high school students. Thus, this study aims to determine the prevalence of smoking among high school students of Thimphu, Bhutan as there is maximum number of high school students comprising of different culture. The self- structured questionnaires were distributed to a sample of 357 students of the total determined using Yamane formula. The overall prevalence of smoking were 48.5% (n=164) while 51.5% (n=193) were non-smokers. In comparison with both of the gender male 63.6% (n=113) smoke more than female 28.3% (n=51). Students smoke different forms of tobacco product such as Cigarette, Cigars, Hookah, Bidis but the most commonly used tobacco product was found to be Cigarette 63.4% (n = 102).The most common reasons cited for children to start using tobacco are peer pressure, parental tobacco habits, etc.The risks of tobacco use are highest among those who start early and continue its use for a long period. The early age of initiation underscores the urgent need to intervene and protect this vulnerable group from falling prey to this addiction. Key words: Motivation, Onset, Prevalence, Perception of smoking, Secondary Students, Thimphu-Bhutan. 1 1.1 Introduction Smoking is the most important cause of preventable death worldwide (Sharkawy & Ghada, 2011). Each year a great amount of money are being wasted in smoking. Smoking is dangerous and injurious to heath but still a large number of people especially teenagers do smoke (Khurshid, 2012). The World Health Organization (WHO) estimates more than 1.1 billion smokers worldwide, with more than 80% of them living in low and middle-income countries (Sukaina, 2014). Smoking is often associated with ill-health, disability and death from non-communicable chronic diseases. It is also reported that tobacco smoking is associated with an increased risk of death from communicable diseases (WHO, 2015). The 2013 World Health Assembly called on governments to reduce the prevalence of smoking by about a third by 2025, which would avoid more than 200 million deaths from smoking (Peto, 2014). WHO has estimated that there are about 1100 million smokers worldwide and this represents about one-third of the global population aged over 15 years (Memomet al.,2000). The greatest increase in prevalence of regular smoking occurs between the age of 12 and 15(Saxena, 2001). Cigarette smoking has been identified as a major public health problem worldwide (Boshtam, 2004). Bhutan is believed to have been one of the first countries to have a smoking control law as early as the 18th century based on the belief of religion and culture significance (Givel, 2009). However, as the time passes there is an increase in the use of tobacco product particularly among the younger generations. This scenario may be attributed to the increasing pace of modernisation and wider communication, expanding access to electronic and print media (Ugen, 2003). Despite the strict surveillance and the smoking control act in place, youth are increasingly found smoking. 1.2 Problem Statement Smoking is considered to be a chief preventable premature cause of death all over the world.Smoking largely contributes to growing public health burden (Bhardwaj, 2012). Despite the efforts of antismoking campaigns and legislation enacted to control smoking, many youth smokers are already addicted to nicotine (Gale, 2004). This is the age where the inspiration is at the maximum level and adolescents are more conscious of their personality, styles and making up their role models. However, in the recent years, it is increasingly seen that youths are smoking in nooks and corners of Thimphu city and creates lots of problem in 2 the city. Now a day’s smoking such as cigarette, hookah, cigars, bidis, has become a fashionable culture among the youths in the country. The risks of tobacco use are highest among those who start early and continue its use for a long period. The early age of initiation underscores the urgent need to intervene and protect this vulnerable group from falling prey to this addiction. The most common reasons cited for children to start using tobacco are peer pressure, parental tobacco habits, etc. More seriously, it has become a national issue and our government is trying its best to control tobacco and other tobacco product. This gives a fair amount of information on the prevalence of smoking users in the high school. Yet very limited study is conducted on the subject matter. Therefore, this study aims to study the prevalence of smoking among high school students in Thimphu. There is no account of the survey being conducted in the rest of the high school apart from the Global Youth Tobacco Survey and further, the data on tobacco use in Bhutan is limited to national level only. There is still scope for study to be done at the district and institute level. 1.3 Objectives To determine the prevalence of tobacco use among the students of high school in Thimphu Dzongkhag 2.0 Materials and Methods The study will be conducted among high school students of Thimphu Dzongkhag because Thimphu being the capital of Bhutan and has highest number of high school students as well as the high rate of crime than the other higher school in Bhutan. 3 Image 1: Study area Thimphu showing four selected schools Thimphu records the highest crime with 1,314 cases registered, states the Annual Crime Statistics for 2012-2013(BBS, 2014). Moreover, 17% of the country’s high school students are in Thimphu(RGOB, 2013).There are eight high schools under MOE in Thimphu, of which four school, which are Yangchenphug High school, Dechencholing High School, Kelki High School and Nima High School were chosen for the study. Study area is shown in Image 1 for visual reference. 2.1 Sample size Target population was 3074 students of classes’ 11 & 12 in four high schools in Thimphu respectively. Population estimation was based on assumption by the school authority since we went to collect data in the beginning of the academic session where the admission was still on full swing. The sample size was determined by using Yamane formula n = N/ (1+Ne2). Where N = 3074, e = 5%. According to this formula, the minimum sample size required was 354. However, for more representative of the sample 357 students were surveyed and thus, findings are based on 357 students. 4 2.2 Sampling Multi stage random sampling technique was used to identify the study participants which involved two stages. The first stage involved a selection of schools from a list of 8 higher secondary schools within Thimphu municipality. Using simple random sampling in 4 higher secondary schools were selected which account about 50% of the total high schools in Thimphu. A second stage involved the selection of students from selected schools. All 49 sections in 4 selected Higher Secondary Schools were listed and using simple random sampling method 15 sections were selected. However, proportionate sampling was employed in order to get representative in each school. 2.3 Data Collection Procedures 2.3.1 Primary Data Collection Proper approval was sought from the principals of selected high schools and then self- administered questionnaires were distributed to the students on agreed date and time. They were assured that their individual data would be used only for this study and kept highly confidential. To ensure the privacy, students were not asked to mention their name. The questionnaire had 22 questions and took less than 10 minutes to finish. The filled questionnaires were collected immediately after completion. Data were collected from all the schools in the month of March 2017. 2.3.2 Secondary Data Collection Secondary data were collected from numerous sources such as books, journals, magazines and websites in the process of my research writing. 2.4 Data Analysis The data collected were analyse using MS excel and SPSS program version 20. Descriptive statistics were presented with the use of percentage, frequency, charts and cross tabulation among different variables. 5 4.0 Results and discussion 4.1 Sample Characteristics The respondents comprised of more women 51.5% (n = 184) than men 48.2% (n = 173). The more women respondents were observed in other studies as well Lim et al.,2006.Proportionately, 20.7% (n = 74) students were of Dechencholing HSS, followed byKelki HSS 25.2% (n = 90), Nima HSS, 23.8% (n = 85) YHSS and 30.3% (n = 108). Subject wise classification shows that majority of the respondents 45.9% (n = 164) were with Arts background, followed by Commerce 43.4% (n=155) and Science 10.6% (n = 38). The age of the respondents ranges between 14-25 years with the mean age of 18.22 (SD = 1.81) year. The majority of the respondents 60.8% (n = 217) were within the age group of 17-19 years, 19.6% (n = 70) of 20-22 years, 17.4% (n = 62) of 14-16 years and only 2.2% 6 (n=8) in the age group of 23-25 years. With regard to the living arrangement, there are more students who stay with parents and siblings with 53.2% (n = 190) and 14.0% (n=50) respectively.
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