Abstract
Introduction
Tobacco is a major risk factor for non-communicable diseases, although the prevalence of tobacco use among adults in Cambodia has decreased, with approximately 1.6 million adults in Cambodia smoking. The smoking prevalence among adolescents aged 13-15 years was 3.5%, but it quickly reached 21% once they became adults. Overall, the prevalence of smoking was 28.4% among men and 2.4% among women. This study aimed to understand the reasons encouraging young adults aged 18–25 years in Preah Vihear Province to begin smoking by examining personal, social, and institutional factors, including their perceptions, societal norms, and environmental factors, that influence their smoking decision.
Methods
A qualitative method was used, including 6 FGDs (8-10 per group) and 12 in-depth interviews (IDIs) with current young male smokers aged 18-25 years who lived in the urban and rural areas of Preah Vihear. IDI was used to explore detailed stories of each participant related to behavior and their social norm toward smoking, whereas FGDs were used to provide detailed data about the perceptions, feelings, thoughts, and impressions of participants through group interaction. Thematic analysis was employed.
Results
Among all current smokers, 33.3% were aged 18-21 years, and the rest were aged between 22-25 years. The percentage of start-up smokers aged 16-18 years was 54.2%. Petty cash sellers, farmers, and construction workers accounted for more than half of the young smokers (56.3%). Three themes emerged: (1) individual factor - beliefs that smoking relieves stress, prevents insect bites, or, for e-cigarettes, has a pleasant aroma alongside low perceived health risks; (2) social influence - peer influence and family acceptance normalizing tobacco use; and (3) environmental factor - easy product access, low prices, single-stick sales, free samples, and pervasive advertising.
Conclusion
This study revealed that smoking initiation among young adults in Preah Vihear is driven by personal perceptions, social norms, and an enabling environment, reinforcing tobacco acceptability and accessibility. Therefore, prevention strategies should enforce age restrictions, ban single-stick sales and point-of-sale advertising, and deliver targeted education through schools, communities, and social media, with the active involvement of local leaders in anti-smoking campaigns.