Smoking among adolescents : relation to school success , socioeconomic status , nutrition , and self-esteem

Tobacco use is a serious problem among adolescents. The relation between lung cancer, chronic obstructive lung disease, coronary artery disease and smoking has been shown in various studies [1–4]. As a result, almost all developed countries have launched vigorous campaigns to diminish smoking rate among adolescents. On the other hand smoking has been spreading rapidly among young people in developing countries. Concomitant to the psychological changes and risk-taking behaviour that are observed during adolescence, tobacco use rate increases. Statistics from the USA indicate that 20% of adolescents smoke cigarettes [5]. In preparing this report, we were mindful of past findings on associations between tobacco use and different factors, but we tried to add new evidence on this topic. In order to develop effective strategies to fight this harmful addiction, it is essential to know why adolescents commence or carry on smoking. This study was designed to evaluate the smoking behaviour and the related factors among a representative sample of middle and high school students of Edirne, a Turkish city with 115 000 inhabitants. It is clear that smoking is an intricate health problem with many interlaced factors, giving rise to the hypothesis that there are many social, environmental, behavioural or inborn factors, which affect the smoking status of adolescents. Since these factors could also have inter-item associations, using a logistic regression model could reveal significant factors for smoking. Hence, we decided to conduct a study evaluating factors related Objective: Smoking is a worldwide health problem. This study was designed to evaluate the current status and to examine some potential factors affecting smoking among adolescents. Design: Descriptive, cross-sectional study. Setting: Community based study. Subjects: Of all middle and high school students in Edirne, Turkey, 883 (6.83%) were randomly sampled. Mean age of the subjects was 15.0 ± 1.8 years. Method: A self-applied questionnaire was used to collect demographic data, smoking status, school success, nutritional behaviour and self-esteem. The influence of different factors on smoking was evaluated with a logistic regression model. Results: There were 89 active smokers (11.1%) with the critical age of 15 years for smoking commitment. 609 students (71.9%) were exposed to environmental tobacco smoke. Nutritional behaviour rich in vegetables (OR = 0.813), high school success (OR = 0.807), longer time reserved for homework (OR = 0.718) and eating breakfast (OR = 0.353) were significantly associated with a lower smoking rate. Having a mother, who smoked (OR = 2.155), increasing age (OR = 1.704), increasing number of siblings (OR = 1.351) and eating fast food (OR = 1.150) were associated with significantly higher smoking rates. Conclusion: An educational programme aimed at changing behaviour and attitude to tobacco smoking and including nutritional counselling with high emphasis on the transition age from early to late adolescence may be a successful primary prevention. In addition projects designed to improve school performance may lead to a reduction in smoking rates while providing an investment in the future of the teenagers.