Abstract
Introduction
Tobacco use remains a persistent global health concern. In the Western Pacific Region (WPR), tobacco alone has claimed 3 million lives annually, including over 490,000 nonsmokers who are exposed to secondhand smoke. Tobacco use annually costs $663 million in healthcare expenses and invisible productivity losses caused by early deaths, disabilities, and breaks for smoking. Despite the prohibition of the sale of tobacco products to minors, the prevalence of current tobacco usage among school students remained a concern, at 2.4%. It is crucial to deter young people from using tobacco products to reduce disease and death rates. Nearly 90% of adult smokers picked up the habit during their teenage years or early adulthood. We aimed to investigate the factors associated with ever tobacco use among secondary and high school students in Cambodia.
Methods
We analyzed data from the Cambodia Global Youth Tobacco Survey (GYTS) 2016, a nationally representative sample of secondary (grades 7-9) and high school students (grades 10-12) with a total of 3,716 participants. The overall response rate was 81.0%. GYTS used a two-stage cluster sampling design. A weighting factor was taken into account to adjust for nonresponse and for unequal probability selection. Multiple logistic regression models with stepwise backward regression were performed to identify the main predictors of ever tobacco use via adjusted odds ratio (AOR) with 95% CIs. The significance level of alpha (0.05) was used to test the statistical significance.
Results
Most of the students (65.8%) were aged 15-17 years, and 34.2% were aged 11-14 years. Boys accounted for 43.6% of the sample. More than half (63.2%) of the participants were in secondary school. Overall, 15.1% of them had ever used any type of tobacco. Ever tobacco use was found to be associated with both parents' smoking, with AOR = 2.06 (95% CI: 1.06-4.00); close friends smoked, with AOR = 5.63 (95% CI: 2.83-11.21); and their teachers smoked (AOR = 2.43, 95% CI: 1.51-3.93), making them feel comfortable at a social gathering (AOR = 1.68, 95% CI: 1.20-2.34) and believing that smoking made them more attractive (AOR = 1.51, 95% CI: 1.08-2.10).
Conclusion
Factors such as having friends who smoke, the perception of attractiveness, comfort and fit in their social circle, smoking parents, and the visibility of teacher smoking were significantly associated with ever tobacco use among secondary and high school students. It is crucial to consider targeted intervention strategies to educate smoking parents, address peer dynamics through educational interventions, and have law enforcement prohibit tobacco sales to those aged under 18. In the school setting, enhancing school-based tobacco control policies and imposing strict penalties on teacher smoking should be prioritized to reduce tobacco use, not only among students but also among teachers.