Protective Factors related to Smoking among Brazilian Youth*

r e S u M e n El objetivo del presente estudio fue investigar la relación entre clima familiar positivo, bienestar en la escuela y religiosidad/espiritualidad entre grupos de jóvenes brasileños fumadores y no fumadores. La muestra no aleatorizada estuvo compuesta por 1.232 participantes (631 varones y 601 mujeres) que completaron un cuestionario elaborado para la investigación. Las edades de los jóvenes variaron entre 14 y 18 años (media = 15.68; DT=1.26). Los jóvenes fumadores presentaron menos clima familiar positivo y bienestar en la escuela de manera significativa que los jóvenes no fumadores. El análisis de regresión mostró que todas las características psicológicas actuaron como factores de protección para la conducta fumadora entre las jóvenes mujeres. Por otro lado, altos niveles de bienestar y de presencia en la escuela durante el día pueden actuar como un factor de protección para los jóvenes varones. Estos resultados pueden ser importantes en la elaboración de políticas públicas para reducir el consumo de tabaco. Palabras clave autores: Conducta del adolescente, tabaquismo, tabaco, factores de riesgo. Palabras claves descriptores: Conducta del adolescente, tabaquismo, políticas pública, Brasil. * This research was in part supported by World Bank. Authors thank to Robb Crouch (University of Nebraska-Lincoln) for the English revision and to J’aims Ribeiro for the collaboration with the construction of data set. ** Programa de Pós-Graduação em Psicologia, Av. Unisinos 950, São Leopoldo, RS, Brazil. CEP: 93022-000. Correo electrónico: [email protected] *** Programa de Pós-Graduação em Psicologia, Rua Ramiro Barcelos 2600, Porto Alegre, RS, Brazil. CEP: 90035-003. maycoln l. m. teodoro, elder cerqUeira-santos, normanda araUjo de morais, silvia h. Koller 140 Un i v e r s i ta s Ps yc h o l o g i c a v. 7 no. 1 e n e r o-a B r i l 2008 Smoking is considered one of the challenges of public health in the modern societies by the World Health Organization (WHO). It is responsible for four million deaths a year, which corresponds to 1900 deaths a day (WHO, 1998). Tabagism can also be associated with a vast range of diseases such acute myocardial infarction (Avezum, Piegas & Pereira, 2005), and major depression (Breslau, Kilbey & Andreski, 1991). Moreover, smoking is affiliated with other drug use including alcohol. In Brazil, Chaieb and Castellarin (1998) found that among alcoholics, 67% are smokers, and among non-alcoholics only 44% are smokers. Prior researchers have found similar results regarding the prevalence of smoking among Brazilian youth. Carlini, Galduróz, Noto and Nappo (2002) investigated adolescents in ages 12 to 17 and found a prevalence rate from 15.7% (16.2% of males and 15.2% of females). Malcon, Menezes and Chatkin (2003) found a total of 12% of smokers in their sample. Similar results were found by Muza, Bettiol, Muccillo and Barbieri (1997) showing prevalence rates of 15.8% smokers among adolescents. Higher rates were found by Galduróz, Noto, Nappo and Carlini (2005) in their study of 107 Brazilians cities, in which 19.2% of the sample had smoked in the last month and 19.5% in the last year. Research about the prevalence of smoking has been contradictory regarding gender in literature. Some Brazilians authors have found a significant higher number of male smokers than female smokers (Barbosa, Carlini-Coltrin & Silva-Filho, 1989; Muza et al., 1997) or did not find any difference (Horta, Calheiros, Pinheiro, Tomasi & Amaral, 2001; Malcon et al., 2003). However, studies in others countries found a higher prevalence of female smokers (Altobelli et al., 2005; Ivanovic, Castro & Ivanovic, 1997; Pinilla, González, Barber & Santana, 2002). Age also seems to be an important factor related to smoking. A large number of researchers from different countries found that older adolescents smoke more than younger adolescents (Ahmed, Brown, Gary & Saadatmand, 1994; Barbosa et al., 1989; Ivanovic et al., 1997; Malcon et al., 2003; Muza et al., 1997). Concerning age, it is important to point out that younger adolescents who engage in early smoking experimentation may look after peers whose members are smokers, increasing their own probability to become a future smoker (Fergusson, Lynskey & Horwood, 1995). On the other side, smoking in late adolescence can be a powerful predictor to smoking in adulthood (Fagan, Brook, Rubenstone & Zhang, 2005). Many factors differentiate groups of smokers and non-smokers, such as lack of stability in the family context, suicidal ideation, suicide attempts, attitude towards harmful effects of smoking, low involvement in sports and frequency of substance abuse (Altobelli et al., 2005; Pinilla et al., 2002; Tomori, Zalar, Plesnicar, Ziherl & Stergar, 2001). Moreover, to have a smoker as a best friend and to live with a smoker makes the probability of youth becoming a smoker higher (Hestick, Perrino, Rhodes & Sydnor, 2001; Pinilla et al., 2002). In the same direction, it was found that adolescents living with both of their biological parents smoke less than those who live with only one parent. Also, the quality of communication about smoking was associated with higher probability of smoking (Barrett & Turner, 2006; Harakeh, Scholte, De Vries & Engels, 2005). Also, Doherty & Allen (1994) found that low family cohesion and parents who smoke were predictors of smoking among adolescents. Besides family aspects, literature has shown that schooling also seems to influence smoking and can work as a protective factor. Adolescents who were not at school or had low formal education, low achievement at school or a period of attendance of school at night have greater probability to become smokers (Barbosa et al., 1989; Horta et al., 2001; Malcon et al., 2003). In the same vein, Pinilla et al. (2002) found that some factors related to school, like complying with non-smoking rules, affect the smoking behavior of youth. Use of tobacco was also related to religiosity and spirituality. Religiosity is related with specific beliefs and practices within an institution, and its definition can also include the concept of spirituality, defined as a more individualized practice of worship (Longo & Peterson, 2002). Religiosity has been associated with lower levels of tobacco Pr o t e c t i v e Fac t o r s Re l at e d t o sm o K i n g a m o n g Br a z i l i a n yo U t h Un i v e r s i ta s Ps yc h o l o g i c a v. 7 no. 1 e n e r o-a B r i l 2008 141 use among older adults (Roff, Klemmack, Parker, Koening, Sawyer-Baker & Allman, 2005). Similar results were found by Pirkle and Richter (2006), in which low levels of religiosity were associated with tobacco use among females. Regarding religiosity affiliation, Ahmed et al. (1994) studied African Americans and found that Pentecostal women have a lower chance of becoming smokers, compared with those who belong to other religious denominations. In contrast with Pirkle and Richter, these authors did not find any significant association between smoking and ones level of religiosity. Regarding spirituality, researchers have found a relation between lower levels of spirituality and smoking, suggesting that this life aspect can work as a protective factor (Hestick et al., 2001; Leigh, Bowen & Marlatt, 2005). Since smoking is a risk factor for youth that decreases their quality of life, it is important to know which factors can increase its probability of occurrence. Unfortunately most research in Brazil is linked to the prevalence of smoking behavior among groups, emphasizing variables such as gender, age, and illicit drugs use. Relations between smoking behavior in Brazil and its risk and protective factors have not been explored yet. The effects of those predictors related to gender also need to be investigated. The aim of this research was to explore the relation between some psychosocial characteristics (positive family climate, well-being at school and religiosity/spirituality) and Brazilian youth groups of smokers and non-smokers. Moreover, it examines how these characteristics may act together with demographic variables, such as period of school attendance and mother education, as protective factors against smoking behavior.