Understanding Smoking Behaviour among Secondary School Students in Amman, Jordan: A Qualitative Study

Background: Tobacco smoking is the most preventable cause of death in many countries. Globally, it accounts for 4.9 million deaths per annum, 70% of which occur in developing countries. With the growing economic development of countries in the ‘East’ and ‘South’, the international tobacco industry has been shifting its marketing towards these areas. Evidence shows that the majority of the smokers start smoking as early as high school level and the number of young smokers is increasing rapidly, which is a concern. In Jordan, smoking has reached alarming proportions, but as yet limited data is available about young Jordanians’ smoking behaviour. This research is an attempt to bridge the gap. Methods: A qualitative study was conducted on secondary school students of Amman, the capital of Jordan in 2010. The participants of the study were 16-18 year-old students of public and private schools in eastern and western suburbs of Amman, who were recruited using stratified random sampling. Five focus group discussions (FGDs), two for males and three for females with six participants per group were conducted. The FGDs used open-ended questions to focus discussion on four broad areas: smoking behaviour, reasons and place of smoking, accessibility of tobacco products, and quitting smoking. Results: The results show that 40% of students were current smokers, and that 66.7% of these were males. The age at which they started the habit was as early as 11 among males and 16 among females. Family environment was found to be positively associated with participants’ smoking behaviour. Hookah smoking was considered socially acceptable in some families, with the perception that it was less harmful than cigarettes. Females tended to smoke alone within contained/secret places, whereas males were more likely to smoke in a group environment on the street or near where they lived. ‘Stress’ was the main reason for participants to start and/or continue smoking, followed by ‘peer pressure’, ‘belonging’ and ‘being cool’. Other factors such as easy accessibility, availability and money issues also played an important part in their smoking. The health risks and consequences of smoking were underestimated by the students, and they expressed no interest in quitting or taking familial advice against smoking seriously. Fear that their fathers might learn of their habit and the possible consequences thereof, i.e., ‘harsh punishment’, was a prime factor for students not to smoke. Despite legislation, students were able to obtain tobacco products easily. The school environment was an important predictor of students’ smoking as teachers smoked within the school vicinity, even in the lass, and the school curriculum did not tackle the issue of tobacco appropriately. Conclusion: Certain measures taken to control youth smoking have not been effective due to lack of understanding of how young people perceive smoking and hence act. This paper sheds some light on 16-18 years old students’ smoking behaviour, factors that encourage their smoking and areas where attention is needed to prevent youth smoking.