|Year : 2014 | Volume
| Issue : 2 | Page : 93-96
Exposure of undergraduate students to cigarette adverts: A case study of University of Abuja, Nigeria
Obiageli E Nnodu1, Mustapha A Jamda2
1 Department of Haematology, College of Health Sciences, University of Abuja, Gwagwalada, Nigeria
2 Department of Community Medicine, College of Health Sciences, University of Abuja, Gwagwalada, Nigeria
|Date of Web Publication||18-Aug-2014|
Dr. Mustapha A Jamda
Department of Community Medicine, University of Abuja, Gwagwalada
Source of Support: None, Conflict of Interest: None
Context: Cigarette smoking has became prevalent particularly in developing countries where youths get initiated at an earlier age than in the past two decades and there is only rudimentary support for smoking cessation. Although the relationship between cigarette smoking and health hazards is well documented, the incidence of cigarette smoking continues to increase despite global and local tobacco control efforts.
Aims: The study objective was to determine the level of exposure of respondents to cigarette smoking and the factors associated with it.
Materials and Methods: A pre-tested, self-administered questionnaire was used to collect data on socio-demographic features, knowledge about smoking and exposure to media for health information including exposure to tobacco adverts. Subjects were selected by multistage sampling technique.
Results: One-third of the students were current smokers and most of them had poor knowledge of the consequences of smoking. All of the students were exposed to some level smoking adverts through electronic/print media. Over 90% of the students had no exposure to smoking prevention and none of the smokers were exposed to cessation interventions. One-fifth believed they were not at health risk as a result of smoking. The school had no smoking control policy.
Conclusions: There was a strong, constant exposure of the youths to cigarette adverts in the media, on the streets, the school and homes. There is need to protect the youths from such excessive exposures to factors that encourage smoking and establish intervention strategies to prevent continued exposure to cigarette adverts.
Keywords: Nigeria, advertisements, smoking, knowledge, tobacco products, youths
|How to cite this article:|
Nnodu OE, Jamda MA. Exposure of undergraduate students to cigarette adverts: A case study of University of Abuja, Nigeria. J Med Trop 2014;16:93-6
| Introduction|| |
Cigarette smoking has increasingly become a major public health challenge than it has ever been in history. , This is due to the progressive increase in the number of persons that smoke cigarette, even as more is known about the health risks associated with cigarette smoking. , The prevalence of cigarette smoking is now expanding to persons that were either non-smokers or had low prevalence: women and young people. , The threat posed by cigarette smoking is what led the World Health Assembly in 1987 to initiate the marking of every May 31 st as the World No Tobacco Day to draw attention to the harmful effects of cigarette smoking on health and promote its control using the WHO Framework Convention on Tobacco Control (FCTC). Thus, the 2013 theme for World No Tobacco Day is "Ban Tobacco advertisement, promotion and sponsorship" to emphasize the negative effect of advertisement and other forms of marketing on the control efforts. 
Tobacco control requires a workable institutional framework to succeed, aside from individual efforts. Institutional framework is lacking or inadequate in the developing countries, even where these laws exist, for example the law against smoking in public places (restaurants, pups, offices, etc.) in the Federal capital territory, (it) is hardly enforced.  Although infectious diseases contribute most significantly to the burden of diseases in our society, cigarette smoking is a common major modifiable risk factor to both communicable and especially non-communicable diseases too huge to be neglected. Health-related adverse consequences of cigarette smoking are worsened by other prevalent conditions in Nigeria such as HIV/AIDS, tuberculosis, malaria and poverty. However, little gain of tobacco control programs is countered by advertisement, promotions and sponsorships by the tobacco companies. This is more so when it is targeted at youths, because once they get addicted they will smoke for a very long time. Youths, including students are mostly non-wage earners, as such the economic cost of smoking has implications not only for their health but nutrition and education as well. Thus the negative health implications of cigarette smoking cannot be ignored.
Statement of the Problem
It has been documented that the prevalence of cigarette smoking globally is on the increase. , This is particularly so in developing countries where the prevalence was relatively low, compared to the developed countries. , This is attributed to weak control mechanisms in the developing countries -lack or poorly enforced legislations, inadequate monitoring lack of smoking cessation support, and poorly regulated advertisement. Studies on the effect of nicotine and pattern of smoking suggest that the metabolism of nicotine is slower in African Americans by some genetic mechanism thus exposing them to greater harm resulting from smoking than Caucasians.  This coupled with bombardment of youths and other vulnerable populations of developing countries by uncensored advertisements by tobacco companies will lead to an explosion of smokers in these countries except preventive measures are put in place. The developing tropical countries are fast turning into an attractive place for tobacco companies, who are escaping unfriendly business conditions such as high taxations, high cost of labor and restricted advertising in the developed countries, to establish tobacco factories, where there are inadequate and poorly enforced laws and cheap labor.
Despite the large body of knowledge on the harmful effects of cigarette smoking gained from medical research over the years, the prevalence of smoking continues to increase while the age of initiation is reducing. In addition, the society has become more tolerant to smoking even at un-designated places.  It is not clear why this is the case, whether is it due to lack of information about the harmful effects of smoking or that they are knowledgeable but lack the skills to regulate the smoking habit.
Rationale for the Study
There is scanty data, particularly in the developing countries, on the burden, drivers of the smoking epidemic among youths and exposure to advertisements. Coupled with the higher risk posed by cigarette smoking when started at youth, due to the potential long period of smoking and difficulty to achieve cessation, it is pertinent to know the drivers of cigarette smoking and level of exposure to cigarettes adverts among students. This is the first step toward development of effective tools and methods for tobacco (cigarette smoking) control. ,,
The study was set out to assess the proportion and pattern of smoking and levels of exposure to cigarette smoking influences including advertisements both in the school and at home among students of University of Abuja Nigeria.
| Methodology|| |
The study was carried out among undergraduate students of university of Abuja, Federal Capital Territory, Nigeria. The school has a regular student population of about 18,000. Descriptive, cross-sectional design was used. A multistage proportionate sampling method was used at the levels of college/faculty, department and class with recruitment of participants done proportionate to size. In the first stage faculties were randomly selected from a sampling frame made of list of all faculties/college; in the second stage, the total minimum sample size was distributed to all selected faculty/college proportionate to their sizes; in the third stage, a department was randomly selected from a faculty/college; in the fourth stage, the sample allocated for each selected department was then distributed to each level of study proportionate to size. A minimum sample size of 400 (including 10% added for non-response) was arrived at using the prevalence study formula. 
Information was obtained using a pre-tested (in a different higher institution of learning), semi-structured, self-administered questionnaires. The questionnaire was designed to obtain information on socio-demographic characteristics, smoking habit, and levels of exposure to cigarette smoking influences particularly advertisement from the respondents.
Data was manually collated and checked for errors. Analysis was done using SPSS version 16-computer statistical software programme. Socio-demographic characteristics were presented as frequencies and proportions. Pattern of cigarette smoking and its influences were analyzed against socio-demographic characteristics using inferential statistics as applicable. Statistical significance was set at P < 0.05.
Ethical clearance was obtained from the ethical committee of University of Abuja Teaching Hospital, Gwagwalada. The objectives of the study were explained to the respondents; thereafter data was collected from those that give a written consent.
| Results|| |
The mean age of the respondents was 22.85 ± 3.66 years with a range of 16-40 years. Ninety percent of the respondents were single, 60% were males and 40% were in the second year of study. One hundred and thirty two (33%) of respondents were current smokers, while 153 (38.2%) were lifetime smokers. Sixty six percent of current smokers (88) were male. Respondents have a preferred brand of cigarette but could smoke any available brand. The choice of a brand of cigarette was not dependent on the perceived level of risk associated with the brand.
Thirty-four respondents (9.1%) were aware of the health hazards associated with cigarette smoking including development of cancer. Sixty-one (21%) of respondents (64% of smokers) were aware of being at risk of developing health problems later in life as a result of their current smoking habit. Eighty-eight (66%) of current smokers were still sure they will continue smoking cigarette, despite knowledge of any potential health hazards. Thirty-seven (9%) of respondents were aware of facility/personnel that could assist with tobacco cessation.
Exposure to Media and Tobacco Adverts on Media
One hundred (25%) of the respondents read newspapers daily, 264 (66%) two to three times a week and 35 (8.8%) rarely. Out of the 87 respondents that reported watching television, 40 (45%) watch daily, 23 (27.4%) two to three times a week and the remaining 24 (27.6%) rarely. Forty-four (50%) of those that watch television reported exposure to cigarette adverts daily while the remaining half reported exposure at least twice a week. Three hundred and twenty (80%) respondents listen to radio daily. One hundred and eighty (56%) of those that listen to radio reported exposure to cigarette adverts on radio daily. Two hundred and ninety six (74%) of respondents had seen cigarette adverts on billboards on the streets. Out of the 296 respondents that reported exposure to cigarette adverts on billboards, one hundred and sixty (54%) reported daily exposure. The radio stations they listen to include ASO FM station 93.8 (73%), Federal Capital Territory FM 98.6 (50%) with some listening to both. The exposure situation was similar with home videos (Nollywood, African Magic and other local television stations among others), where 73% of respondents had watched actors smoking or seen adverts for cigarettes smoking on television/videos. The level of exposure to adverts varies with the frequency of watching movies.
None of the respondents had attended any campaign against cigarette smoking in the university campus. One hundred and thirty two (33%) respondents had attended a campaign or public lecture about cigarette smoking but outside the university.
University Environment and Cigarette Smoking
Fifty-five (13.7%) respondents had observed teachers/staff smoke in their offices or within the University compound. The University has no policy on cigarette sales and smoking within its premises. Thus, there is unrestricted access to cigarettes in the campus (kiosk) and just outside the school gate as reported by the respondents.
| Discussion|| |
The higher proportion of sampled males could be the reflection of the higher population of males in the University of Abuja. The prevalence of cigarette smoking from this study (33%) is higher than the figure reported in previous studies in the developing countries. ,, This may be because there was higher proportion of males, who are reported to smoke more than females, in the University of Abuja. All studies in the country had reported higher prevalence of smoking among males compared to females. ,, However, the prevalence of smoking among females in this study was much higher than was reported in other studies among students. ,,,,
Thirty three percent of the respondents were current smokers at the time of the study at a mean age of 22.6 years. ,, This is higher than the figures reported by studies conducted among students in Nigeria. ,, Among the smokers, there were more males (66.4%) than females. The prevalence of smoking was also related to age: The older ones had higher chances of being smokers than the younger ones as reported by other studies.  This increasing prevalence of smoking in young adults with age is attributed to increased exposure to influences that encourages smoking and reduction of parental control as the students' age and leave home for school.
Thirty four percent of the respondents were aware that smoking is harmful to health. There were smokers with knowledge of negative effects of smoking compared to those that do not smoke. One of the health hazards mentioned by the respondents (28%) was cancer. Based on this, 84% of the respondents desired to quit smoking. Despite the desire, more than two-thirds of those that smoke were sure they would not be able to quit in the near future. This is as reported by previous studies that those that smoke are aware of the negative effects especially health wise but are not able to stop because of the addiction to cigarette smoking.
Students and youths generally are reported to use many brands of cigarette. This is because they depend mostly on gift or sharing cigarettes rather than on purchasing, due to their low purchasing power. , Smoking cessation services (manpower, drugs, equipment etc.) are scarce in the developing world. In the whole of FCT, for example, there is no government facility that offers comprehensive tobacco cessation services.
The respondents have access to common sources of tobacco use adverts: Newspapers (92.2%), television (72.4%) and radio (97%). All of the respondents had seen advert about cigarette smoking on the television, radio or newspapers. Thus the number that accesses the advert on the television is much due to the fact that about half of them access television, billboards, radio or newspapers daily. This is significant exposure to the negative effect of advert that has been reported to influence youths towards cigarette smoking in Uganda, China and Tanzania. ,
The exposure rate to the media is much higher than reported for general population in Africa, even among youths. Thus, students have higher exposure to media, including advertisements than adults. , Thus, the same sources of negative information (media) could be used to reach them with intervention messages against cigarette smoking.
In addition to the influence of media, the social environment is reported to have negative impact on both initiation and cessation of cigarette smoking among youths.  More than two third of the students had observed a staff/lecturer smoke cigarette in the school compound. Theses serve as advert since the staff members are expected to serve as role models to the students.
The University is located in the Federal Capital Territory where an act had banned cigarette smoking in public places.  Thus, the school should enforce the Federal Capital Territory's ban in the campus. Further study should be conducted to determine the major drivers of cigarette smoking among the students and the possible ways to protect them. There should be improved effort by the school authority to educate the students about the negative consequences of smoking and take steps to make the environment less friendly to smoking at entry during orientation and subsequently: Such actions could include prohibition of sale of cigarette within or around the school campus make the campus no smoking zone, enforce prohibition of sale of tobacco products to persons less than twenty one years of age. The University should in addition provide smoking cessation services in the campuses.
| Acknowledgement|| |
The authors acknowledge with gratitude, the summer curriculum on cancer prevention fellowships at the national cancer institute, Bethesda, Maryland, USA in 2007 for OEN and 2008 for MAJ" that gave birth to the idea of the study. We also register our appreciation to the students that volunteered to participate in the study and the management of University of Abuja for permitting us conduct the study.
| References|| |
|1.||Ibeh CC, Ele PU. Prevalence of cigarette smoking in young Nigerian females. Afr J Med Med Sci 2003;32:335-8. |
|2.||Yang G, Ma J, Chen AP, Brown S, Taylor CE, Samet JM. Smoking among adolescents in China: 1998 survey findings. Int J Epidemiol 2004;33:1103-10. |
|3.||Mpabulungi L, Muula AS. Tobacco use among high school students in Kampala, Uganda: Questionnaire study. Croat Med J 2004;45:80-3. |
|4.||WHO Global Tobacco Report 2012. World No Tobacco Day 2013 available at www.who.int/tobacco/wntd/2013/en, [Last accessed on 2014 Apr 8]. |
|5.||Fielding R, Chee YY, Choi KM, Chu TK, Kato K, Lam SK, et al. Declines in tobacco brand recognition and ever-smoking rates among young children following restrictions on tobacco advertisements in Hong Kong. J Public Health (Oxf) 2004;26:24-30. |
|6.||Omokhodion FO, Faseru BO. Perception of cigarette smoking and advertisement among senior secondary school students in Ibadan, Southwestern Nigeria. West Afr J Med 2007;26:206-9. |
|7.||Pérez-Stable EJ, Herrera B, Jacob P 3 rd , Benowitz NL. Nicotine metabolism and intake in black and white smokers. JAMA 1998;280:152-6. |
|8.||Priest N, Roseby R, Waters E, Polnay A, Campbell R, Spencer N, et al. Family and carer smoking control programmes for reducing children′s exposure to environmental tobacco smoke. Cochrane Database Syst Rev 2008;CD001746. |
|9.||Thomas RE, Baker P, Lorenzetti D. Family-based programmes for preventing smoking by children and adolescents. Cochrane Database Syst Rev 2007;CD004493. |
|10.||Thomas RE, McLellan J, Perera R. School-based programmes for preventing smoking. Cochrane Database Syst Rev 2013;4:CD001293. |
|11.||Jekel JF. Sample size randomization and probability theory. Epidemiology, Biostatistics and Preventive Medicine. Philadelphia, USA: WB Saunders Company; 1996. p. 163-5. |
|12.||Borders TF, Xu KT, Bacchi D, Cohen L, SoRelle-Miner D. College campus smoking policies and programs and students′ smoking behaviors. BMC Public Health 2005;5:74. |
|13.||Crawford MA; Tobacco Control Network Writing Group. Cigarette smoking and adolescents: Messages they see and hear. Public Health Rep 2001;116 Suppl 1:203-15. |
|14.||Pampel F. Tobacco use in sub-Sahara Africa: Estimates from the demographic health surveys. Soc Sci Med 2008;66:1772-83. |
|15.||Townsend L, Flisher AJ, Gilreath T, King G. A systematic literature review of tobacco use among adults 15 years and older in sub-Saharan Africa. Drug Alcohol Depend 2006;84:14-27. |
|16.||Riley W, Obermayer J, Jean Mary J. Internet and mobile phone text messaging intervention for college smokers. J Am Coll Health 2008;57:245-8. |
|17.||Whittaker R, McRobbie H, Bullen C, Borland R, Rodgers A, Gu Y. Mobile phone-based interventions for smoking cessation. Cochrane Database Syst Rev 2012;11:CD006611. |
|18.||Warren CW, Lea V, Lee J, Jones NR, Asma S, McKenna M. Change in tobacco use among 13-15 year olds between 1999 and 2008: Findings from the Global Youth Tobacco Survey. Global Health Promot 2009;16 Suppl 2:38-90. |
|19.||Rodgers A, Corbett T, Bramley D, Riddell T, Wills M, Lin RB, et al. Do u smoke after txt? Results of a randomized trial of smoking cessation using mobile phone text messaging. Tob Control 2005;14:255-61. |
|20.||Riou França L, Dautzenberg B, Falissard B, Reynaud M. Are social norms associated with smoking in French university students? A survey report on smoking correlates? Subst Abuse Treat Prev Policy 2009;4:4. |
|21.||The Abuja Smoking Ban. Editorial. This Day Newspaper (ng). Available from: http://www.allafrica.com/stories/200806250224.html. [Last accessed on 2014 Mar 08]. |