Journal of the National Institute of Public Health2012 Vol.61 No.1 p.50−55<Educational Report>
GORIN Team No.2
Post Graduate Public Health in International HealthNational Institute of Public Health, Japan

Tobacco use survey among public health students
in the University of the Philippines, Manila.
フィリピン大学における公衆衛生学部生と大学院生の喫煙に関する調査
Emmanuel H. KOOMA, Mohammad Yousuf MUBARAK, Hu MEIQIN
Keywords: GHPSS, tobacco use, smoking, public health students, university of the Philippines.
Supervisors: Nobuyoshi WATAHIKI, Nobuyuki HYOI, Michiko BANDO

Ⅰ．Introduction
1. Background
Much research has been car ried out in the area of
tobacco use and has been found that tobacco use is among
the leading causes of preventable premature deaths due todisease and disability [1]. Out of the eight leading causesof world deaths is caused by tobacco use [2]. Deaths due
to tobacco, will increase to 10 million by the year 2020,
if the current tobacco use epidemic continues and morethan 70% of the deaths are expected to occur in developing
countries [3]. Smoking, which is one of the major risktaking behaviors, is responsible for the health burden
on the society more than any other drug. Public healthprofessionals should have a leading role in the prevention
and control of smoking in the community they ser ve.
Brief inter ventions by public health professionals cansubstantially reduce smoking rates in the community [4].
Their profession and the ser vices they offer to ser ve thecommunity are impor tant in the development of publichealth policies. Public health students who are future publichealth law enforcers and promoters have a vital role to play
in tobacco use prevention, control and cessation efforts.
The Global Health Professional Students Survey (GHPSS)of 2005, showed that 38% of males and 18% of females werecurrent tobacco users among the third year pharmacy
students in the College of Public Health of the Universityof the Philippines [5].There is vast body of evidence on thecontrary that smoking is high in medical and public healthtertiary schools of learning. These students lack knowledge
on tobacco use cessation techniques and smoking relateddiseases [6].

5Because of high increase in disease related to smoking,various governments remain concerned about the uptakeof smoking by young people, which perpetuate tobacco
use and subsequent poor health in the communities.
The government of the Philippines introduced a seriesof legislations and policies on the prevention and control
of tobacco use and a ban on smoking in all indoor andoutdoor public places, including work places; ban on all
tobacco advertising; mandator y printed warnings on all
cigarette packages; increased taxes on tobacco products;
and promoted the implementation of programs related
to cessation approaches [7].Our study determined theprevalence of tobacco use and related awareness on theprevention and control approaches among public healthstudents in the College of Public Health in the University of
the Philippines, Manila. Our hypothesis was “The expectedawareness of ‘role model’ of Undergraduates and MPH
students in controlling tobacco use is different”.
2. Objectives of the Study
Previous sur veys, under the framework of the GHPSS
concentrated on the third year medical, pharmacy, nursing
and dentistry students [8]. This survey, aimed at assessing
the knowledge, attitude and practice on tobacco use among
public health students to influence a prevention and control
program in the University of the Philippines [9]. In orderto achieve the proposed main objective, specific objectives
were set as follows: (i) to determine the prevalence of
tobacco use among Undergraduates and graduate MPH
students in the College of Public Health,( ii) to describe
environmental exposure to second hand smoke among
public health students, (iii) to evaluate knowledge andJ．Natl．Inst．Public Health，61（1）：2012Educational Report FY 2011 : GORIN Team No.2
attitudes of public health students towards smoke bans, (iv)
to describe tobacco- use cessation behavior among publichealth students (v) to describe the curriculum and training
activities for public health students in smoking cessation
approaches and techniques.

Ⅱ．Methods
This was a cross-sectional study targeting publichealth related students proper by use of (GHPSS) corequestionnaire designed by World Health Organization(WHO) for health learning institutions in WHO Member
States. The sur vey was conducted from the 14th -19thof November, 2011, in the University of the Philippines
using the GHPSS modified questionnaire and adding a
few questions on the demographic, knowledge, attitude
and practice, exposure to environmental tobacco smoke
sections. The target populations were first year, second
year of public health Undergraduates and MPH students
in the College of Public Health in the University of thePhilippines. The sur vey was carried out in class rooms
during regular lecture sessions. The sur vey followed ananonymous identity approach and the questionnaire was
self-administered for data collection. List of definitions wasprovided on, tobacco uses, type of smoke and ex-smokers[10]. The study investigated the knowledge, attitude andpractice on tobacco use and made recommendations thatwill influence the prevention and control program in the
University.
The total sample for the sur vey was 215; 75 were firstyear students, 71 were second year students and 69 were
Master of Public Health students, respectively.
The survey assessed six areas namely,(i)socio-demographic,(ii) tobacco use prevalence,(iii) exposure to environmental
tobacco smoke,(iv) knowledge, attitude and practice,(v)behavior and cessation and ,(vi)curriculum and training.
The onsite obser vations were also made especially for
health promotion posters and leaflets.
The Conceptual Framework in Figure 1 was drawn fromthe six components of the survey assessment tool developedby WHO (GHPSS). However, a number of factors outside
the university such as influence of media, peer, and family
that was not included in the study.

Fig 1

Conceptual Framework on the contributing factors totobacco use control and cessation approaches

The study received a review approval from the National
Institute of Public Health Ethical Review Board (NIPHIBRA 11027). The infor med consent for m was used
before the inter views. Data generated from inter views
and questionnaires were analyzed by use of Epidata 3.1.
Statistical analyses were conducted with the use of SPSS
version 15.0.
The literature review was classified into five categories asfollows:(i) Prevalence of tobacco use in youths,(ii) second
hand smoke(iii) environmental exposure to tobacco use (iv)behavior and cessation (v) Curriculum and training. The
Philippines has one of the highest percentages of young
smokers across the Asian Countries. It was stated that 30%of the adolescents in the Philippines urban areas smoke.
Of these, more than 70% star ted smoking between theages of 13 and 15 years old. Although risk-taking behavior
is considered as part of developmental stage, adolescentsengage in dangerous and health compromising behaviors[8].

Ⅲ．Results
The total number of respondents was 215, out of whom
75 were first year Undergraduates, 71 were second year
and 69 were MPH public health students. The prevalenceof current-smokers among public health students was 6.1%,
and the prevalence of ex-smokers was 27.6%. According
to the sur vey, 71.9 % of Undergraduate respondents and69.6% of MPH respondents believed that they ser ve as“Role Model” for their community members and the public.
Out of the 215 respondents, 55.6% of Undergraduates (146
respondents) and 58.2% of MPH students (69 respondents)
think they did not get enough knowledge about smoking.

J．Natl．Inst．Public Health，61（1）
：2012

5

Emmanuel H. KOOMA, Mohammad Yousuf MUBARAK, Hu MEIQIN(emily)
The prevalence of smoking among public healthstudents was low compared to previous GHPSS results in
the Philippines; however, it was suggested that the rate ofsmoking should be reduced to present more non-smoking
role models in the communities. As for the expected rolemodels in the communities, 47.9% of the Undergraduates
described the expected role model as “by not smoking andencouraging others to stop smoking in the community”,
while 24.6 % of the MPH students only mentioned it.

comparing Undergraduate students with MPH students, theprevalence of smoking (current smokers and ex-smokers)
among MPH students was higher than Undergraduate
students (Male: 70.8% vs. 35.6%, p=0.005; Female: 44.4% vs.
19.0%, p=0.001) (Table 2).
Table 2

Prevalence of smoking among public healthstudents by grade

Current smoker

Ex-smoker

Non-smoker

Total

Male
FemaleMale
FemaleMale
FemaleMale
Female（n, %） （n, %） （n, %） （n, %）（n, %） （n, %） （n, %） （n, %）1. Demographic characteristics of respondents
The total number of targeted students was 245 and a totalof 217 students were present during survey, from which 215
students participated in the study and two students did not.
The respondents were fairly distributed in three groups,
74 students were in first year, one of them did not respond,
70 students in second year and 69 students were MPH
students. Among them all, 68.1% were females. The mean
age of the respondents was 21.7years and the average age
for the first year, second year and MPH students was 16.7,
17.8 and 31.2 years, respectively. The key socio-demographic
characteristics of the respondents are summarized in table
1.

Undergraduate 2（4.4） 2（2.0） 14（31.1）17（17.0）29（64.4）81（81.0）45（100）100（100）

MPH students 5（20.8） 4（4.1） 12（50.0）16（35.6）7（29.2）25（55.6）24（100）45（100）

Subtotal

Total

7（10.1） 6（4.1） 26
（37.7）33（22.8）36（52.2）106（73.1）69（100）145（100）

13（6.1）59（27.6）

142（66.4）

Among all the current and ex-smokers, the initial age
was 11-15 years of starting smoking. The smoking rate
was 48.6% for Undergraduate students whose age was 1819 years and 27% for MPH students whose ages ranged
within 20-24 years old (Figure 2)

Table 1 Demographic characteristics of the respondents
Male
No. ofrespondentsn（%）

FemaleAge
M±SD

No. ofrespondents
n（%）

14.3

Total
Age
M±SD

No. ofrespondentsn（%）

214（100）

Age
M±SD

0

0

0

37.1
48.6

First Year 19（27.9） 16.6 ± 0.7 55（37.9） 16.7 ± 0.7 74（34.7） 16.7 ± 0.7
PHSUndergraduates（n=35）
Second25（36.8） 17.9 ± 0.6 45（31.0 ） 17.7 ± 0.6 70（32.9） 17.8 ± 0.6
Year PHS
MPH
students

24（35.3） 28.3 ± 7.1 45（31.0 ） 32.7 ± 7.7 69（32.4） 31.2 ± 7.7

Total

68（100） 21.2 ± 6.8 145（100） 22.0 ± 8.4 213（100） 21.7 ± 7.9

Age 10 or younger
Age 11-15
Age 16-17
Age 18-19
Age 20-24

PHS:Public Health Students
Note: One ﬁrst year student from Undergraduates
and another from second year did not respond.

2. Tobacco use prevalence among healthprofessional students
Nearly all public health students had high understandingof the consequences of smoking; Undergraduates were
97.3%, and MPH students were 97.7% respectively. Out of thetotal number of students, 13 (6.1%) were current smokers,
59 (27.6%) were ex-smokers and the remaining 142 (66.4%)
were non-smokers. Among males, 7 students were current
smokers where as 26 of them were ex-smokers. Among thefemales, 6 students were current smokers while 33 of themwere ex-smokers. Comparing the males and females, theprevalence of current smokers among male students washigher than female students (10.1% vs. 4.1%) and that of exsmokers was 37.7% for males and 22.8% for females. When

52

24.3
21.6

5.4

10.8
27
10.8

MPH students（n=37）

Fig 2 Distribution of initial age of smoking among current
smokers and ex- smokers.

3. Exposure to environmental tobacco smoke(second hand smoke)Among all the respondents, nearly 60% were not exposedto smoking in their living places during the past 7 days.
When stratified by smoking status, the percentage range

J．Natl．Inst．Public Health，61（1）：2012Educational Report FY 2011 : GORIN Team No.2
was 38.6%, 64.4% and 60.1% for current smoker, ex-smoker
and non-smoker, respectively (Figure 3). There was no
significant dif ference between percentage of smokers(including current smokers and ex-smokers) and nonsmokers (p=0.778).

Fig 3 Frequency of exposure to smoking in the living places
Fig 5 Attitude towards smoke ban

During the past 7 days, non-smokers frequency of
exposure to smoking in public places was high on 1 to 2 days
(26.2%) and during all the seven days (29.8%), respectively
and there was significant difference between smokers andnon-smokers (p=0.022). A total of 23.1% of current smokers,
44.1% of ex-smokers and 29.8% of non-smokers were notexposed to smoking in the public places during all the past 7days (Figure 4).

5. Expected role model
The Undergraduate students (47.9%) were found to
be more involved than the MPH students (24.6%) in
encouraging community members to stop smoking. The
Undergraduates (27.4%) had also almost similar interest
with MPH students (27.5%) in implementing promotion
activities that improved lifestyles of the communities. The
MPH students (18.8%) had provided cessation approaches
and had knowledge of smoke ban strategies than the
Undergraduates (7.5%).This was justified by the MPH
Students being already in employment service (Table 3).
Table 3 Expected role model
Expected activities

Fig 4 Frequency of exposure to smoking in public places

4. Knowledge, Attitude and Practice
The results indicated a high level of knowledge (97.7%)
about tobacco use and cessation techniques among the
public health students. Therefore, training public healthprofessionals in tobacco use control and cessation would
equip them with more knowledge in implementing
pr omotion activities in their communities. Among
Undergraduates and MPH students, the positive response
regarding advertising of tobacco products and banning in
discos/bars/pubs was low compared to restaurants andpublic places (Figure5).

Expected role model in the community
by not Smoking and encouraging others
to stop smoking
Promotion activities, improve lifestylecondition and strengthening of
advocacy measures regarding tobacco
control
Cessation approaches and knowing
smoke ban strategies

Provision of education and training
to the community about dangers
and health risk of smoking and othertobacco use
Preventive activities and Anti- Tobacco
Campaign

Undergraduate
studentsn（%）

MPH
students
n（%）

Total
n（%）

70
（47.9%） 17（24.6%） 87（40.4%）

40（27.4%） 19（27.5%） 59（27.4%）

11（7.5%） 13（18.8%） 24（1 1.1%）

6（10.3%） 14（20.2%） 29（13.4%）

10（6.8%）

6（8.6%）

16（7.4%）

Total number of respondents

J．Natl．Inst．Public Health，61（1）
：2012

146
（100%） 69（100%） 215（100%）

53

Emmanuel H. KOOMA, Mohammad Yousuf MUBARAK, Hu MEIQIN(emily)

Ⅳ．Discussion
Our results confirmed that the prevalence of smoking
among public health students was low compared to previous(GHPSS) of 2007 results of third year pharmacy students;
however, it was suggested that the rate of smoking should
be reduced to present more non-smoking public healthstudents role models in the Philippines. The provision ofhealth promotion activities to the community members
could have a positive ef fect on smoking habits of thecommunity, including tobacco cessation approaches for
public health students for their playing a significant role in
the prevention and control of tobacco use. Therefore theUniversity of the Philippines should consider training publichealth students in cessation techniques and approaches.
The results show that public health students recognize thatthey are role models in society.
1. Prevalence of Tobacco Use
The prevalence of tobacco use among public healthstudents was 6.1%; 2.8% for Undergraduates and 13% for
MPH students, respectively. The results suggested that
expected role models for the Undergraduates and MPH
students were dif ferent. The prevalence of tobacco use
among public health students in the College of Public
Health in the University of the Phillipines, Manilla was 6.1%
which was low compared to the previous GHPSS results ofpharmacy students in 2007.
This study did not go deeper in identifying the reasonsof lower prevalence; however, the influence on student`sknowledge, attitude and practice was the result of the
University programs which were seen as the common
influential factors. On the other hand, public health students
believed that they served as “role model” for the community
they serve. None of the previous studies as well as our study
identified the reason male students tend to smoke morethan females.
2. Environmental Exposure (second hand smoke)
The school policy follows the Philippines government anti
smoking law which restricts smoking in public places andin school premises which also protects non smokers fromsecond hand smoke exposure. The majority of the students
indicated that there were smoking bans in the University
buildings/clinics and also smoking ban was being enforcedby the University authorities. Most exposures to tobacco
use were indicated to be from the living dormitories outside
the University premises. The University had less authority
over the ownership of living dormitories.
3. Knowledge, Attitude and Practice
Knowledge about the tobacco use and smoking cessation
techniques among public health students was relatively high54

among the current smokers, ex-smokers and non smokers.
The public health students also showed commitment in their
responses to serve as “role model” for the community they
serve.
4. Tobacco Use Training and Cessation Techniques
Both Undergraduates and MPH students indicated theneed to acquire knowledge; especially the Undergraduateswere more willing to undergo training and felt those alreadyworking in the field had not done so much to prevent andcontrol tobacco use both in the University of Philippines
and in the communities where they live. Therefore, thisstudy suggested that 6.1% of tobacco use prevalence wasstill high. It was supposed to be zero since public healthstudents were the “role model” as promoters and educators
to the community. Therefore, it was very important for the
University to intensify leaflet distribution on sensitization of
the students and the public about tobacco use prevention
and control and class teaching on smoking cessation
approaches, techniques and on effects of tobacco use law
enforcement on the prevention and control measures.

Ⅴ．Conclusion
The prevalence of tobacco use among public healthstudents was 6.1% (2.8 % for Undergraduates, and 13.0% for
MPH students, respectively).Nearly all the public healthstudents (93.3% for Undergraduates and 97.7% for MPH
students) had high understanding of the consequencesof smoking and had positive attitudes towards tobacco
use control and ban. It appears that the results suggestthat expected role models for Undergraduates and MPH
students be different.

Ⅵ．Limitation of Study
Limitation to the current study included the definition
by WHO-GHPSS of “Ex- Smoker” which was not clear tocategorize and more detailed information was not obtained
to compare the results of the previous similar sur veys.
Finally, the results were not generalized because only one
school was covered in our study.

Ⅶ．Recommendations
We recommend that some topics about cessation
techniques be included in the curriculum because thestudents after graduating from the College of Public
Health, the University of Philippines play a vital role in theircommunities for cessation and control of tobacco use. Public
Health students have a role in their communities to support

J．Natl．Inst．Public Health，61（1）：2012Educational Report FY 2011 : GORIN Team No.2
smokers to quit smoking.

Acknowledgements
We owe our deepest gratitude to the College of Public
Health, University of the Philippines, Manila, for the moral
and material support rendered to us during the proceedingsof the sur vey. Many endless thanks go to Dr. Nina G.
Gloriani, Prof Janathan Guevara and the support staff. Many
thanks also go to our Supervisors and supporting staff from
National Institute of Public Health-Saitama –Japan. We also
extend many thanks to JICA, Tokyo for financial support
other logistics.

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