Anti-smoking initiatives and current smoking among 19,643 adolescents in South Asia: findings from the Global Youth Tobacco Survey

BACKGROUND Cigarette smoking habit usually begins in adolescence. The developing countries in South Asia like Pakistan, India, Bangladesh, and Nepal, where the largest segment of the population is comprised of adolescents, are more susceptible to smoking epidemic and its consequences. Therefore, it is important to identify the association between anti-smoking initiatives and current smoking status in order to design effective interventions to curtail the smoking epidemic in this region. METHODS This is a secondary analysis of national data from the Global Youth Tobacco Survey (GYTS) conducted in Pakistan (year 2003), India (year 2006), Bangladesh (year 2007), and Nepal (year 2007). GYTS is a school-based survey of students targeting adolescents of age 13-15 years. We examined the association of different ways of delivering anti-smoking messages with students' current smoking status. RESULTS A total of 19,643 schoolchildren were included in this study. The prevalence of current smoking was 5.4% with male predominance. No exposure to school teachings, family discussions regarding smoking hazards, and anti-smoking media messages was significantly associated with current smoking among male students. Participants who were deprived of family discussion regarding smoking hazards (girls: odds ratio (OR) 1.56, 95% confidence interval (CI) 0.84-2.89, p value 0.152; boys: OR 1.37, 95% CI 1.04-1.80, p value 0.025), those who had not seen media messages (girls: OR 2.89, 95% CI 1.58-5.28, p value <0.001; boys: OR 1.32, 95% CI 0.91-1.88, p value 0.134), and those who were not taught the harmful effects of smoking at school (girls: OR 2.00, 95% CI 0.95-4.21, p value 0.066; boys: OR 1.89, 95% CI 1.44-2.48, p value <0.001) had higher odds of being current smokers after multivariate adjustment. CONCLUSION School-going adolescents in South Asia (Pakistan, India, Nepal, and Bangladesh) who were not exposed to anti-tobacco media messages or were not taught about the harmful effects in school or at home had higher odds of being current smokers than their counterparts.