Egbe et al. BMC Public Health 2014, 14:1204 http://www.biomedcentral.com/1471-2458/14/1204 RESEARCH ARTICLE Open Access An exploratory study of the socio-cultural risk influences for cigarette smoking among Southern Nigerian youth Catherine O Egbe*, Inge Petersen, Anna Meyer-Weitz and Kwaku Oppong Asante Abstract Background: The increase in smoking prevalence in developing countries including Nigeria has been mainly blamed on the aggressive marketing strategies of big tobacco companies. There is a paucity of research on other socio-cultural risk factors for smoking among the youth. The main objective of this study is to explore and describe socio-cultural risk factors influencing cigarette smoking among the youth in Southern Nigeria. Methods: A total of 27 respondents (5 community leaders, 4 political analysts and 18 young cigarette smokers) were interviewed using a semi-structured interview guide. Interpretative Phenomenological Analysis (IPA) was used to analyse the data. Results: Social-cultural practices fuelling early usage and exposure of children to cigarettes and the promotional activities of tobacco companies were identified as possible factors influencing youth’s smoking behaviour in Southern Nigeria. Conclusion: Tobacco control policies should include cultural interventions to modify current traditional practices and social norms which fuel the use of tobacco in the society. Such interventions must target specific groups, subpopulations and subcultures more exposed to the cultural risk influences for smoking. Keywords: Youth, Cigarette smoking, Cultural practices, Tobacco policy, Nigeria Background in 2008 [5]. The prevalence rate obtained from the The World Health Organization (WHO) estimates that national survey carried out in 2002 was 8.6 [6]. Results nearly six million people die of tobacco related diseases from the Nigeria demographic and health survey (NDHS) around the world annually [1]. Despite efforts aimed at 2008 found that 3.06% of adults aged 18 to 29 years and reducing the number of people picking up the habit of 9% of adults aged 15–49 years smoke cigarette [7,8]. The smoking, prevalence rates are still high in many parts of World Report on the Global Tobacco Epidemic [9] shows the developing world especially in Africa and Asia [1,2]. smoking prevalence among Nigerian youth to be 3.5% as Sub-Saharan Africa accounts for 2% of the world 11% at 2008. A more recent Global adult tobacco survey population who are smokers [3]. (GATS) carried out in 2012 found that 3.7% of adults aged There are conflicting evidences on the actual prevalence 15 years and above smoke cigarette in Nigeria [10]. In the of cigarette smoking in Nigeria. Individually conducted face of these conflicting reports however, Drope reports studies in parts of Nigeria show a considerably high that the smoking prevalence among adolescents and smoking prevalence rate for example; 17.6% obtained young adults in Nigeria is on the increase [11] just like in among rural dwellers in the South-west region in 2003 many developing countries as mentioned earlier. [4] and 31.9% among adults in North-Eastern Nigeria The increase in smoking prevalence in developing countries (including Nigeria) has been mainly blamed on the aggressive marketing strategies of big tobacco com- * Correspondence: [email protected] Discipline of Psychology, School of Applied Human Sciences, College of panies [3,12]. However, many aspects of tobacco use are Humanities, University of KwaZulu-Natal, King George V Avenue, Durban controlled by culture [13]. The tobacco plant and tobacco 4041, South Africa © 2014 Egbe et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Egbe et al. BMC Public Health 2014, 14:1204 Page 2 of 9 http://www.biomedcentral.com/1471-2458/14/1204 products like snuff and cigarettes are also symbolic in nationality while the South-south has a diversity of smaller many traditions across the world [14,15]. Meanings sur- ethnic nationalities including the Ijaw, Urhobo, Edo, Itsekiri rounding tobacco use differ across cultures. Early societies and Ibibio ethnic groups among others. Participants have viewed tobacco smoking as a symbol of hospitality, were a purposive sample of 27 community members (using communication with the gods and spirits and possessing snowball sampling technique) in three categories namely; 5 the healing power to chase away diseases [15]. Some community leaders (sampled from the three geopolitical cultures view tobacco smoking as a prestigious behaviour zones in southern Nigeria), 4 political analysts/NGOs offi- resulting in great personal satisfaction [16]. Studies have cials (PA) and 18 young male smokers (YS) aged between also shown some cultural explanations of smoking behav- 18 and 24 years (mean age of 23 years). This sampling iours across some ethnic groups within and outside Nigeria technique was appropriate as it enables the researchers to [13,14,17]. In a study of five ethnic groups across eleven recruit selected participants according to their ability to states in the USA, Mermelstein and colleagues [17] found provide rich information on the phenomenon under study striking differences across ethnic and gender sub groups in [22]. All the young tobacco users were males. They reasons for not smoking. Further studies in Asia also found include; Young smoker (YS) university undergraduates culturally specific contexts for smoking among Bangladeshi (YS-US: n = 3); ‘other students’ i.e. students of other and Pakistani adults with tradition, culture and the family tertiary institutions aside the University (e.g. Colleges of playing significant roles in nurturing and cultivating norms Education, Polytechnics etc.) (YS-OS: n = 4); skilled and values around smoking [18]. In a study carried out workers (YS-SW: n = 5) and unskilled workers (YS-USW: in North-Eastern Nigeria, it was found that being of the n = 6). The mean age of smoking initiation was 15.2 years. Margi, Hausa and Fulani Ethnic tribes were strongly Majority of young smokers (n = 12) have had education associated with smoking [6]. up to the secondary school level, and all participants had a These aforementioned studies indicated the need for fur- close friend who smokes. Seventeen out of the 18 young ther investigations of this seemingly cultural phenomenon smokers had a family relative who smokes and the same [19,20]. However, there is a paucity of research in this area number of young smokers had attempted to quit smoking. within Southern Nigeria. We are therefore not fairly in- Community leaders are regarded as the custodians of cul- formed about the socio-cultural risk factors for smoking ture in traditional Nigerian settings. They are sometimes among the youth in Nigeria. The main objective of this appointed to lead or could be the oldest man in the com- study is to explore and describe the socio-cultural risk munity as is most often the case in South-south Nigeria. factors influencing smoking among young smokers. The Community leaders were purposively sampled from specific question addressed in this study is: what socio- Anambra, Edo and Ondo states in Southern Nigeria. cultural factors influence smoking among the youth in The inclusion of the three categories of respondents Southern Nigeria? Findings from the present study provide served the purpose of triangulating the data obtained in a phenomenological overview of risk factors for smoking in this study and the reduction of bias in interpretation of Nigeria. Findings will further facilitate policy development participants’ responses. This was ensured by including in of tobacco control interventions sensitive to the contexts the three interview schedules used to guide the inter- within which smoking is initiated and perpetuated among view, some questions cutting across the different groups the youth. of respondents. Methods Data collection Design Data were collected by the first author by means of The qualitative design was considered appropriate for twenty-four individual interviews and one small focus this study as it allows the researchers to capture the group discussion comprising of three community leaders words, perceptions and experiences of participants and (from south-west Nigeria). The interview with the for “thick and rich” descriptions of the issues under South-west community leader turned out to be a focus study [21]. group discussion involving three participants because two other elders of the community who were visiting Participants and setting the community leader (earlier contacted) at that time This study was carried out in southern Nigeria, which also volunteered to participate in the interview since has seventeen states with only one (Osun state) having the discussion concerned their cultural practices. All a functional state-enacted tobacco control policy [11]. interviews with community leaders took place in their Southern Nigeria is divided into three geopolitical zones respective communities (in their residences) while the (south-east, south-south and south-west zones). South- interviews with young smokers took place at various eastern Nigeria is home to the