Tobacco-promotional activities in rural Sri Lanka: a cross-sectional study of knowledge, exposure and responses among adolescent schoolchildren.

BACKGROUND Tobacco promotions are linked to tobacco consumption in adolescents. The aim of this study was to determine knowledge of and exposure and responses to tobacco-promotional activities and factors associated with knowledge among adolescents in a rural setting in Sri Lanka. METHODS Seven schools in Polonnaruwa district were randomly selected for this cross-sectional study. Adolescents (n = 500) aged 14-15 years in grade 10 were selected using convenience sampling and studied by using a self-administered questionnaire during June-October 2014. The questions on exposure to tobacco-promotional activities were based on the validated questionnaire of the Global Youth Tobacco Survey. Adolescents were categorized into two levels of knowledge, exposure and responses to tobacco promotions, based on the scores obtained. Selected factors associated with knowledge of tobacco promotions were assessed using univarate and multivariate analyses. RESULTS The response rate was 99.6% (498/500). The mean age of the adolescents was 14.9 years (standard deviation ±0.37) and the proportion of females was slightly higher (n = 280, 56.2%) than for males. The prevalence of current smoking was 3.2% (n = 16). Half (48.6%, n = 242) of the adolescents had a good level of knowledge of tobacco-promotional activities. Most (64.9%, n = 323) had experienced a low level of exposure to tobacco-promotional activities, while 85.7% (n = 427) indicated that they had responded/would respond assertively to exposure to tobacco promotion. In the univariate analysis, having a mother with a high level of education (odds ratio [OR] 1.742), having a father with a high level of education (OR 1.997) and the student attending a type 1AB school (OR 1.310) were significant factors associated with a good level of knowledge of tobacco-promotional activities. A father with a high level of education (adjusted OR 1.772) and the student attending a type 1AB school (adjusted OR 1.455) were the factors associated with a good level of knowledge for tobacco-promotional activities, when confounding effects of the variables were taken into consideration. CONCLUSION Knowledge of tobacco-promotional activities was poor among the adolescents in the rural setting in Sri Lanka. Nevertheless, most of the adolescents in the study population indicated that their responses to such exposures were/ would be assertive.