The Pathway To Smoking Role Of Family, Peer And Environment In Shaping Adolescent Smoking Behavior

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The Pathway To Smoking Role Of Family, Peer And Environment In Shaping Adolescent Smoking Behavior

  1. 1. SAIDATUL NORBAYA BUANG PUBLIC HEALTH PHYSICIAN FAMILY HEALTH DEVELOPMENT DIVISION DEPT OF PUBLIC HEALTH MINISTRY OF HEALTH MALAYSIA THIRD MALAYSIAN TOBACCO CONTROL CONFERENCE 8 -9 AUGUST 2009
  2. 2. <ul><li>Smoking acquisition is not straight forward process </li></ul><ul><li>Various theories put forward to explained adolescent smoking behavior. </li></ul><ul><li>Strongest predictors is intention to smoke </li></ul><ul><li>Study attempt to understand the process of smoking acquisition experience by Malaysian adolescents. </li></ul><ul><li>Adopt Stage of Change model, Social Learning Theory </li></ul>
  3. 3. <ul><li>Smoking acquisition is a process involving several stages. </li></ul><ul><li>Various factors played different roles in the smoking acquisition process. </li></ul>
  4. 4. <ul><li>Cross sectional, descriptive study of students ages 13 – 17 year </li></ul><ul><li>3 stage cluster sampling with class as the smallest sampling unit . (N=1035) </li></ul><ul><li>Sampling boys to girls ratio 1:3 </li></ul><ul><li>Self administered questionnaire in schools </li></ul><ul><li>Third party consent. ( School Principal as legal guardian for the students) </li></ul><ul><li>Validation of stages using qualitative data – 5 groups of FGD with smoking respondents. </li></ul><ul><ul><li>Respondents selected by discipline teacher ( caught smoking in school) </li></ul></ul>
  5. 6. <ul><li>those who have never tried even a puff of cigarette, no intention to smoke in near future and able to resist peer pressure from smoking. </li></ul><ul><li>720 respondents (68.1%) of study population fall into this category making this the larges smoking subgroup in this study. </li></ul>
  6. 7. <ul><li>are those who have not tried smoking, but either have intention to smoke in near future or view themselves unable to resist peer smoking pressure or both. </li></ul><ul><li>12.2 % (126) of study population were in this subgroup. </li></ul>
  7. 8. <ul><li>those who tried smoking before but quit for various reasons. </li></ul><ul><li>7.1 % (73) of respondents fit into this category. </li></ul>
  8. 9. <ul><li>Irregular smokers are those who admitted smoking regularly but do not smoke on daily basis. </li></ul><ul><li>is the smallest subgroup in this study with 4.6% (51) membership from total study population. </li></ul>
  9. 10. <ul><li>are boys or girls who smoke on daily basis and </li></ul><ul><li>8.0% (83) of study population belongs to this group. </li></ul>
  10. 11. <ul><li>Majority of respondents perceived intention to initiate smoking as being attracted to the cigarette smoke. </li></ul><ul><li>‘ … bila tengok abang-abang tu hembus asap rokok, bulat-bulat … tak tau nak cakap macam mana rasanya ….terasa nak hisap rokok …’ </li></ul><ul><li>F, age 17 </li></ul><ul><li>However many of them were unable to recall the time they developed positive attitude towards smoking. </li></ul>
  11. 12. <ul><li>The process of smoking uptake varies from voluntary trying to being force to smoke. </li></ul><ul><li>‘ … saya biasa lepak … dengan kawan waktu malam. Depa rokok .. Saya tengok, cakap nak cuba … depa tak kasi. Satu hari saya tanya, macam mana rasa rokok? Abang tu ambik rokok kayu ( bantang kayu) suruh saya hisap .. Saya cuba tak rasa apa-apa … esok tu saya beli dan cuba merokok’ </li></ul><ul><li>– H 17 yr old . </li></ul>
  12. 13. <ul><li>‘ In one particular school the smoking initiation was force upon them by elder siblings or a person the students called as ‘abang’… </li></ul><ul><li>‘… abang paksa saya merokok, sebab kita nampak dia merokok … dia ikat saya di kerusi dan paksa saya … Lepas tu dia kata .. Kalau saya cakap pada mak , dia akan cakap saya rokok…..’ </li></ul><ul><li>K – 13 yr old Malay boy </li></ul><ul><li>. </li></ul>
  13. 14. Stages of smoking Mean age (year) Mean age of smoking initiation (year) Non Susceptible Non Smoker (n=702) 15.56 Susceptible Non Smoker (n=126) 15.45 Experimenter Smoker (n=73) 16.09 13.24 Irregular Smoker (n=51) 15.98 14.00 Regular Smokers (n=83) 16.55 13.04 Overall mean age (n= 1035) 15.69 13.35
  14. 15. Stages of smoking Male (N=404) Female (N=631) Total stage of smoking Non Susceptible Non Smoker 24.5% 75.5% 67.8% Susceptible Non Smoker 50.8% 49.2% 12.2% Experimenter smoker 67.1% 32.9% 5.1% Irregular Smoker 78.4% 21.6% 4.9% Regular Smokers 95.2% 4.8% 8.0% Total gender 39.0% 61.0% 100%
  15. 16. Stages of smoking Malay (N= 647) Chinese (N= 148) Indian (N= 240) Total stage of smoking Non Susceptible Non Smoker (N=702) 55.6% 16.7% 27.8% 67.8% Susceptible Non Smoker (N=126) 70.6% 14.3% 15.1% 12.2% Experimenter smoker (N=73) 82.2% 6.8% 11.0% 5.1% Irregular Smoker (N=51) 82.4% 7.8% 9.8% 4.9% Regular Smokers (N=83) 79.5% 4.8% 15.7% 8.0% Total ethnic group 62.5% 14.3% 23.2% 100%
  16. 17. <ul><li>Demographics </li></ul><ul><li>Perceived parent child relationship </li></ul><ul><li>Perceived Family smoking and attitudes towards smoking </li></ul><ul><li>Perceived peer smoking and attitudes towards smoking </li></ul><ul><li>Perceived school variables </li></ul><ul><li>Perceived Social bonding </li></ul><ul><li>Places young people hang out </li></ul>
  17. 18. <ul><li>Transformation of variables values into standardised z score. </li></ul><ul><li>Allow comparison of each smoking subgroups means to the study population mean ( which is 0). </li></ul><ul><li>Of the 39 predictors variables analysed, 14 variables distinguished the 5 hypothetical smoking subgroups from overall study population. </li></ul>
  18. 20. <ul><li>more likely to be younger age group, </li></ul><ul><li>female students who have </li></ul><ul><li>no elder sibling smoking, family members with strict attitude towards smoking and more likely to have no or few friends who smoked. </li></ul><ul><li>They appeared to be bullied in school but denial bullying other and less likely to be truant </li></ul>
  19. 22. <ul><li>seem to have parents with negative smoking attitude. </li></ul><ul><li>less likely to be bullied </li></ul><ul><li>more likely to truant from school than overall sample. </li></ul>
  20. 24. <ul><li>more likely to be boys </li></ul><ul><li>Lower religiosity score </li></ul><ul><li>have many friends in their neighbourhood </li></ul><ul><li>They bullied others but denial being bullied </li></ul><ul><li>spend their leisure time at video arcades and snooker centres. </li></ul><ul><li>Relatively have more elder sibling smoking, </li></ul><ul><li>father with strict smoking attitude but </li></ul><ul><li>pro-smoking brother/s and male friends. </li></ul>
  21. 26. <ul><li>more likely to be older boys </li></ul><ul><li>older in age than mean age of study population. </li></ul><ul><li>They were bullies </li></ul><ul><li>who truant from classes/school. </li></ul><ul><li>Relatively have elder sibling smoking and </li></ul><ul><li>pro-smoking attitude parents and </li></ul><ul><li>Pro smoking attitude of male friends. </li></ul>
  22. 28. <ul><li>older boys who </li></ul><ul><li>bullied other </li></ul><ul><li>truant from classes/school. </li></ul><ul><li>Relatively have more elder siblings smoking </li></ul><ul><li>family members with positive smoking attitude than study population ( parents and older siblings) </li></ul>
  23. 32. PREDICTORS NON SUSCEPTIBLE NON SMOKER TO SUSCEPTIBLE EXP (B) CONFIDENCE INTERVAL   Demographic   Boys 3.59*** 2.19 5.75 Malay 1     Chinese 0.47* 0.26 0.86 Indian 0.56 0.3 1.04 Parent child relationship Father do not understand my problem and worries 3.44*** 1.97 6.03 Friends’ smoking and attitude toward smoking Few to almost all friend smoking 2.15*** 1.45 3.19 Female friends allow smoking 4.03*** 2.28 7.13 School variables   Have thought of leaving school 1.82* 1.11 2.99 Truant from school 1.85* 1.14 3.01 R 2 0.278    
  24. 34.   PREDICTORS SUSCEPTIBLE NON SMOKER TO EXPERIMENTER EXP (B) CONFIDENCE INTERVAL Parent child relationship       Mother do not support when upset 2.86* 1.14 7.14 Family smoking and attitude towards smoking At least one elder sibling ever smoked 2.14* 1.12 4.06 Friend smoking and attitude towards smoking Few to almost all friend smoking 3.47*** 1.89 6.34 Social bonding Religiosity 0.46* 0.22 0.96 R 2 0.216    
  25. 36.   PREDICTORS   EXPERIMENTER TO IRREGULAR SMOKER EXP (B) CONFIDENCE INTERVAL Family smoking and attitude towards smoking At least one elder sibling ever smoked       Parents allow smoking 8.07*** 2.74 23.77 Friend smoking and attitude towards smoking Few to almost all friend smoking 2.25 0.99 5.09 Places where young people hang out Spend time in public places 8.56* 1.57 46.76 R 2 0.378    
  26. 38.   PREDICTORS Irregular to Regular smokers Exp (B Confidence Interval Demographic Age 2.108** 1.201 3.702 Family smoking and attitude towards smoking Elder sister allow smoking 3.4* 1.07 10.77 School variables Poor academic grade 4.04** 1.5 10.88 Risk taking behaviour Bullies in school 3.218* 1.27 8.14 Places where young people hang out Spend time at snooker centre 5.29*** 2.11 13.29   R 2 0.399    
  27. 39. NSNS SNS REGULAR IRREGULAR EXPERIMENTER <ul><li>BOYS </li></ul><ul><li>MALAY </li></ul><ul><li>UNSUPPORTIVE FATHER </li></ul><ul><li>PEER ATTITUDE </li></ul><ul><li>TRUANT </li></ul><ul><li>HATE SCHOOL </li></ul><ul><li>PARENTAL ATTITUDE </li></ul><ul><li>PEER SMOKING </li></ul><ul><li>SPEND TIME IN PUBLIC SPACES </li></ul><ul><li>OLDER BOYS </li></ul><ul><li>SISTER ALLOW SMOKING </li></ul><ul><li>BULLIES </li></ul><ul><li>POOR ACADEMIC GRADES </li></ul><ul><li>SPEND TIME SNOOKER CENTRE </li></ul><ul><li>MOTHER </li></ul><ul><li>OLDER SIBLING SMOKING </li></ul><ul><li>PEER SMOKING </li></ul><ul><li>RELIGIOSITY* </li></ul>
  28. 40. <ul><li>Peer appear to be more important during early stage of smoking … a cigarette shared by 3 -4 person but as the smoking stages advance, smoking alone is more preferred. </li></ul><ul><li>‘ .. Ada duit beli sebatang … tak da duit kongsi kongsi beli ….sebatang dapat hisap 3 ke 4 kali …kongsi 3 kadang 4 orang.. Tak duit pau kat kawan … bila kita beli kawan..pau pulak …’ </li></ul><ul><li>Z, 15 yrs </li></ul>
  29. 41. <ul><li>On the other hands, B who used to smoked a 20 cigarette a day describe … </li></ul><ul><li>‘ ..mula –mula kongsi , lepas tu hisap sebatang … dalam masa setahun naik 7 batang, sekarang dah sekotak sehari. .. Hisap kongsi tak puas, kena sorok nanti depa ‘pau’ …hisap waktu malam, malam sejuk, terasa nak merokok … </li></ul><ul><li>As respondents progress to regular smoker, the importance of peer reduced </li></ul>
  30. 42. <ul><li>Parental acceptance was observed among irregular and regular smoker. </li></ul><ul><li>‘… ayah panggil ..dia tanya hang ada hisap rokok ?.. Saya diam..ayah tak kata apa… lepas tu saya tanya apa beza rokok import ? Ayah cerita …. Lepas tu di tak tanya saya rokok ke tidak’ </li></ul><ul><li>M, 17 yrs </li></ul>
  31. 43. <ul><li>Parental disapprove of smoking, can reverse the smoking progression. </li></ul><ul><li>‘… bila ayah tau dia pukul saya…potong duit belanja… sekarang saya dah tak berani rokok…ayah kata kalau jumpa saya rokok ….’ </li></ul><ul><li>H, 17 yrs </li></ul>
  32. 44. <ul><li>Different predictors influence transition from one stage to another. </li></ul><ul><li>Prevention strategy to promote NO SMOKING needs to address </li></ul><ul><ul><li>Educating ‘Smoking Fatwa’ among young children to promote clear religious stand point regarding smoking. </li></ul></ul><ul><ul><li>Enhance religiosity </li></ul></ul><ul><ul><li>High risk groups population ( boys, truant, bully,) </li></ul></ul><ul><ul><li>Strengthening regulation to prevent sale of ‘loose cigarette’ or sale to minor/ non purchase cigarette source </li></ul></ul>

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