Irshad Ali Shaikh ( Apartment No. 32, Building No. 3, Group No. 71, Al Rehab, Cairo, Egypt )
Masood Ali Shaikh ( Apartment No. 32, Building No. 3, Group No. 71, Al Rehab, Cairo, Egypt )
Zulfiqar Siddiqui ( 268-B, Kamal Road, Cantt. Rawalpindi )
Madam, Cigarette smoking and tobacco use is a global pandemic, and is responsible for some 5 million deaths annually, with half the deaths in developing countries like Pakistan.1-2
Studies on prevalence of tobacco use among class 8 to 10 students in Pakistan are rare and report from one major city i.e. Karachi, and in male students only. One study on the prevalence of smokeless tobacco among male high schools reported a prevalence rate of 16.1%, while another study reported a prevalence of current smoking as 13.7% among male adolescent student in Karachi.3-4
To describe the association of gender, beliefs about quitting smoking after having started smoking, opinions about women who smoke, beliefs about smoking for a year or two and quitting afterwards, having being offered free cigarettes from the representative of cigarette manufacturers, and having seen advertisements for cigarettes on billboards with self-reported tobacco use in class 8 to 10 students in Islamabad and Lahore, and its prevalence; we used data from the Global Youth Tobacco Survey (GYTS) for Islamabad and Lahore, conducted in 2003.5
The GYTS is a collaborative project of the World Health Organization, Centers for Disease Control and Prevention, United States, and the Canadian Public Health Association. We selected all the respondents in class 8 to 10, who responded to the questions of having ever tried/experimented with cigarette smoking and/or having used tobacco products other than cigarettes e.g. snuff or chewed tobacco, during the past 30 days. Students responding affirmatively to these questions were identified as tobacco users. Since in this survey it was not asked whether smokeless tobacco was ever tried/experimented; this particular definition of tobacco use was adopted to reflect ever use of tobacco. A two-stage cluster sample design was adopted for the GYTS-Pakistan (Islamabad and Lahore) to produce representative estimates for class 8 to 10 students. Design-based analysis with SUDAAN 9.1 was done using Logistic regression; Odds Ratios (OR) were computed for the association of tobacco use in the past thirty days with gender, class and various other attributes.
The overall prevalence of tobacco use by the class 8 to 10 students was 11%, and 95% Confidence Interval (CI) was 6%, 15% (n = 3812). In male students prevalence of tobacco use was 16%, 95% CI 8%, 24%, while prevalence in female students it was 6%, 95% CI 4%, 7%. Compared to female students, males were more likely to have used tobacco (OR 2.60, 95% CI 1.42, 4.76). Compared to students who thought that once someone has started smoking, it would be definitely/probably difficult to quit, tobacco users were more likely to think that it would be either definitely or probably not difficult to quit (OR 1.73, 95% CI 1.04, 2.85). And compared to those students who stated that when they see a woman smoking, they think of her as either having lack of self confidence/stupid/loser; tobacco users were more likely to think of her as successful/intelligent/sophisticated (OR 1.58, 95% CI 1.09, 2.29). While compared to students who stated that it is probably/definitely safe to smoke for only a year or two as long as one quits after that, tobacco users were more likely to state that it is probably/definitely not safe to do so (OR 1.7, 95% CI 1.10, 2.61). Compared to students who stated that it is probably/definitely safe to smoke for only a year or two as long as one quits after that, tobacco users were more likely to state that it is probably/definitely not safe to do so (OR 1.7, 95% CI 1.10, 2.61). Compared to students who were never offered free cigarettes, tobacco users were more likely to reply affirmatively to the question of having ever been offered free cigarettes by the representative of cigarette manufacturers so (OR 2.72, 95% CI 1.43, 5.16). However, no statically significant association was observed between having seen advertisements for cigarettes on the billboards and tobacco use. Results of Hosmer-Lemeshow Wald goodness-of-fit test concluded that the model was a good fit for the data.
The results of this unique representative survey of the cities of Islamabad and Lahore, demonstrate that compared to female students, male class 8 to 10 students were more likely to report having used tobacco. The association with various erroneous opinions, attitudes pertaining to tobacco use, and knowledge about the addictive nature of tobacco was strongly associated with tobacco use. It is alarming that tobacco user students of both genders were more likely to perceive women who smoked as more glamorous, felt that it was easier to quit after having started smoking, and were more likely to have been offered free cigarettes by the predatory representatives of cigarette manufacturers. The results augur for the need of legislative action on banning distribution of free cigarettes to adolescents. Furthermore, public health education efforts at identifying adolescents at high risk of tobacco use; for improved health would be particularly beneficial for this school going group, especially male students in Islamabad and Lahore; in addition to professional continuing education of primary care physicians and other cadres of health providers.
1. Republic of Somaliland - Country Profile. (Online) (Cited 2008 Apr 11). Available from URL: http://www.somalilandgov.com/
2. Tobacco control: strengthening national efforts. In: The World Health Report 2003: Shaping the future. Geneva : WHO; 2003: pp 91-5.
3. Ezzati M, Lopez AD. Estimates of global mortality attributable to smoking in 2000. Lancet 2003; 362: 847-52.
4. Global Youth Tobacco Survey (GYTS) Datasets. (Online) (Cited 2008 Mar 11). Available from URL: http://apps.nccd.cdc.gov/GYTSDataSets/