Family Practice Vol. 18, No. 6, 627-628
© Oxford University Press 2001
Original Paper |
Survey of smoking knowledge, attitudes and practice in school children in Honduras
Santa Cruz Medical Clinic, Santa Cruz and
a White Memorial Medical Center Family Practice Residency, Los Angeles, California, USA.
Hamner RT and Stumpf SH. Survey of smoking knowledge, attitudes and practice in school children in Honduras. Family Practice 2001; 18: 627–628.
Received 8 December 2001; Revised 13 March 2001; Accepted 9 July 2001.
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Abstract |
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 Top Abstract IntroductionMethodsResultsDiscussionReferences |
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Objective. The aim of this study was to survey Honduran pre-adolescent knowledge, perceptions and experience regarding smoking.
Methods. A 12-item survey was administered in the classroom to fifth and sixth grade students. The main outcome measures were a description of demographic factors, personal smoking experience, knowledge of health risks, attitudes about tobacco use and perceived sources of information.
Results. A total of 225 students were surveyed. The majority were aware that smoking is bad for health, and most reported never having smoked. Most viewed smoking as ugly. Friends and family were selected as the major source of information.
Conclusions. School children in this area of Honduras are aware of the health risks of smoking and view smoking as unattractive.
Keywords. Honduras, school children, smoking.
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Introduction |
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TopAbstractIntroductionMethodsResultsDiscussionReferences |
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The world is in the midst of a smoking epidemic as multinational tobacco companies turn to the developing world to replace diminishing markets in industrialized nations.1 It is predicted that during the first quarter century, the number of smokers will increase by a half billion, and the number of annual tobacco-related deaths will more than triple to 10 million, with developing countries suffering the greatest impact.2
China, the largest current market for tobacco, is "considered to be in an early stage of the tobacco epidemic".3 Latin America has lagged behind Asia in economic growth. Honduras is one of the poorest nations in the western hemisphere. Less than 1% of overseas tobacco sales were to Latin America in 1988.4 It has been suggested that developing countries in the earliest stages may be the most rewarding areas for preventive measures.5
The most insidious aspect of the tobacco industry's need to build long-term smokers is the need to target and addict children.6 Although there is much information regarding per capita smoking rates, there is a paucity of information regarding children in developing countries. Our review of the literature yielded no similar published surveys of tobacco knowledge, attitudes and practice in Latin American school children.
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Methods |
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An age-appropriate, 12-item survey was created addressing tobacco use in four domains: personal use; perceived health effect; principle sources of information; and perception of smoking. Other items collected identification data. The survey was administered to all of the children present in the fifth and sixth grade classes at all four schools located in the Los Pinos area during November 1996. Los Pinos is an impoverished community on the outskirts of the capital city of Tegucigalpa. Surveys were completed anonymously during class time while proctored by the investigators.
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Results |
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A total of 225 surveys were collected. All available data was examined. There were a total of 146 (59 male, 87 female) fifth graders surveyed with a mean age of 11 years; and 79 (30 male, 49 female) 6th graders with a mean age of 12 years. Survey responses addressing the four domains are reported in Table 1
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The responses did not differ between grade levels and were aggregated. Similarly, the responses to the questions on sources of information were the same for both advantages and disadvantages of smoking, and hence were combined. Since this represents the results of two separate questions, only the percentages are included in the table.
The vast majority of students reported having never smoked and understood that smoking is bad for health. Students primarily saw smoking as unattractive and identified friends and family as a primary source of information.
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Discussion |
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Few of the children surveyed reported having smoked. The survey was anonymous but administerd in the classroom, and often with the teacher present. These factors may have resulted in children not reporting actual smoking behaviour accurately.
Our survey findings suggest that pre-adolescent school children in Honduras are aware of the health risks posed by smoking. However, risk awareness alone seems to be insufficient to deter smoking. On the contrary, some reports show risk awareness to be directly, not inversely correlated to smoking rates in youth.7
It appears that most children we surveyed have not learned to associate smoking with the glamour and machismo depicted in tobacco marketing, such as that embodied in ‘Marlboro Man’.
The survey suggests that friends and family are an important source of information. Similar results for sources of information on ‘advantages’ versus ‘disadvantages’ of smoking may represent the inability of the students to discriminate between these values. Our study was limited by the ability of school-aged children to evaluate abstract concepts, and make value judgments regarding the pros and cons of smoking.
Our survey sample was small. Our study was limited further by not addressing the proportion of children in Los Pinos who attend school, or the percentage of students enrolled who were actually in attendance at the time of the survey. Hence the results may only reflect the attitudes of the children present in school and may not be generalizable to all of the children in this area.
Experience in the USA together with reports from developing countries indicate that tobacco taxes and public health legislation are powerful deterrents to smoking.8 In 1987, smoking was prohibited in the building of the Honduran Secretary of Health. In 1988, a national committee was formed to promote smoking cessation and prevention.
It is encouraging to find that school children we surveyed in Honduras are aware of the health risks associated with smoking. We must continue to support the legislation in developing countries that controls and contains the smoking epidemic. Especially fruitful would seem to be measures that protect children from tobacco marketing. In Latin America, the international campaign against smoking can defuse a public health time-bomb before it becomes an overwhelming public health crisis.
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Acknowledgments |
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The authors would like to thank the Department of Preventive and Community Medicine at the Universidad Nacional Autonomo de Honduras for assistance in administering the survey. This project was supported in part by the American Medical Student Foundation International Health Fellowship Program.
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References |
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1 Peto R, Lopez AD, Boreham J, Thun M, Heath C Jr, Doll R. Mortality from smoking worldwide. Br Med Bull 1996; 52: 12–21.
2 MacKay J. The global tobacco epidemic: The next 25 years. Public Health Rep 1998; 113: 14–21.[Web of Science][Medline]
3
Yang G, Fan L, Tan J et al. Smoking in China: findings of the 1996 National Prevalence Survey. J Am Med Assoc 1999; 282: 1247–1253.
4 Economic Research Service. Tobacco: Situation and Outlook Report. Washington, DC: Economic Research Service, US Department of Agriculture, Report TS-203, 1988.
5
Mackay J, Crofton J. Tobacco and the developing world. In Doll R, Crofton J (eds). Tobacco and health. Br Med Bull. 1996; 52: 206–221.
6 Phillips A, de Savigny D, Law MM. As Canadians butt out, the developing world lights up. Can Med Assoc J 1995; 153: 111–114.
7 Steptoe A, Wardle J, Smith H. Tobacco smoking in young adults from 21 European countries: association with attitudes and risk awareness. Addiction 1995; 90: 571–582.[Web of Science][Medline]
8 Helzman D. Tobacco abroad: infiltrating foreign markets. Environ Health 1997; 105: 178–183.
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