Jallow, Isatou K.
(2019)
Prevalence, risk factors and epidemiology of tobacco use among students; and the implementation of tobacco control polices in The Gambia.
PhD thesis, University of Nottingham.
Abstract
Background
Tobacco consumption, and consequent morbidity and mortality, are expected to grow most markedly over the coming decades in Low and Middle Income Countries (LMICs). The WHO Framework Convention on Tobacco Control (FCTC) was developed in response to the globalisation of the tobacco epidemic and it presents a unique opportunity to reduce the global burden of tobacco. However, data on smoking in LMICs, particularly in sub-Saharan Africa as well as data on the progress of FCTC implementation are limited. The objectives of this thesis were to obtain a reliable and nationally representative estimate of prevalence of smoking, exposure to Second-Hand Smoke (SHS), smoking susceptibility and to identify the major risk factors among young people and to assess current implementation of tobacco control polices in The Gambia.
Methods
Representative samples of students in grades 7-12 in upper and senior secondary schools throughout The Gambia completed a self-administered questionnaire which included questions on tobacco use, risk factors, and demographic details; indicators of exposure to SHS and indicators of susceptibility to initiating smoking. Semi-structured one-to-one interviews were conducted with 28 members of the National Tobacco Control Committee in The Gambia to assess their awareness of the FCTC and national tobacco control policies, and to assess the achievements in and challenges to the implementation of the FCTC.
Results
The sample comprised 50 schools and 210 classes were identified for the survey. Of 10,395 eligible students, 10,289 (99%; 55% girls and 44% boys, age 12-20 years) participated. The prevalence of ever smoking was 16.7% and current smoking 4.5%. Smoking was more common among students attending private schools, of Christian or all other faiths other than Islam, living with parents, who had smoking allowed in their homes, with family members or friends who smoked. Most smokers (55.6%) wanted to stop, but only 22% received any stop smoking support. The proportion of students reporting any exposure to SHS was 97.0%. Parental education, living with parents and being sent to purchase cigarettes were associated with exposure to SHS both within and outside the home. About 35% of students were unaware of the harmful effects of exposure to SHS. Among the 9831 non-smokers, 33.9% were found to be susceptible to smoking. Smoking susceptibility was associated with socio-demographic characteristic, tobacco advertisements and having positive attitudes towards smoking. The interviews with policy makers showed that The Gambia has made modest progress in tobacco control before and since ratification of the FCTC, particularly in the areas of policy formulation. Whilst several pieces of tobacco control legislation exist, enforcement and implementation remain major challenges.
Conclusions
Interventions to reduce tobacco use and exposure to SHS in school children are urgently needed. Raising students’ awareness of the harmful effects of smoking and reducing the prevalence of adult smoking, extending tobacco advertising restrictions to include point-of-sale, are all important established evidenced-based approaches to preventing the uptake of smoking among students. Finally there are needs to step up efforts that will help to accomplish the obligations of the FCTC. To achieve this, The Gambia should develop specific public awareness interventions, establish cessation services, mobilise adequate resources for tobacco control, capacity building and strengthen surveillance and research to inform policy.
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