Predictors of smoking uptake in male adolescents attending public and private schools in urban settings of Karachi, Pakistan

Introduction: Adolescents spend a considerable amount of their time in school, the school environment is therefore important for child health practices and outcomes. Objectives: We aimed to investigate the impact on smoking... [ view full abstract ]

Introduction: Adolescents spend a considerable amount of their time in school, the school environment is therefore important for child health practices and outcomes.

Objectives: We aimed to investigate the impact on smoking behavior of the school environment and the personal characteristics of male teenage students attending schools in Pakistan, taking into account the survey sampling structure.

Methods: A two-stage cluster sampling with stratification was employed, and we interviewed 772 male secondary school students. Since we have students nested within schools we adopted random effect and generalizing estimating equation GEE models.

Results: Peer pressure in particular had a strong influence on adolescents smoking, those who friends smoked were up to 6 times more likely to smoke. Family smoking habits were also significantly associated with increased adolescents smoking, but those students whose mother was more highly educated were 50% less likely to smoke. The fitted random effect model indicated that the between school variability was significantly different from zero (p-value of likelihood ratio test < 0.01), indicating differences in smoking habits between schools. We also fitted a random coefficient model which showed that variability among schools was not significantly different for public and private schools.

Conclusion: Public health campaigns for smoking cessation should not only target the individual but also the families of adolescents attending schools. Parental counseling about the influence of family tobacco use on their children may bring about encouraging results. One of the most important commitments a country can make for future, economic, social, political progress and stability is to address the health and development needs of its adolescents. Random effect models and GEE take correlation into account in the inferential process, indicating that there is variability between schools and we need to take cluster variation into account by using multilevel modeling.