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A cross country comparison of tobacco use among youth in Yerevan

(Armenia) and New Delhi (India)

Student Investigator: Neeraj Kishore Pandey, MD, MPH (c)

Advisor: Byron Crape, MSPH, PhD

Reader : Narine Movsisyan, MD, MPH

Diana Petrosyan, MD, MPH

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OutlineIntroductionMethodsResults Discussion ConclusionRecommendations

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Public health problem of tobacco use

One of major preventable causes of death.Morbidity and mortality:Lung cancer, CVD, COPD, atherosclerosis.Over 4 millions die each year due to smoking 1 death due to smoking every 8 seconds

globally.

Economic impact on family:Smoking diverts money from basic needs. WHO, 2002

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Situation in Armenia

Major public health problem, with a greater impact on urban areas.

Smoking rates among Armenian men one of the highest globally.

Smoking rates: male-60%, female-2% (age group -16 years and above), 2005.

National survey on Drug, Alcohol and smoking prevalence among general population of Armenia, 2005

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Situation in India

Smoking is responsible for half of cancers in men and a quarter of cancers in women

WHO projects tobacco deaths may exceed 1.5 million by 2020 in India.

Smoking rates: male-57%, female-11% (age group -15 to 54 years), 2005-2006.

National Family Health Survey, India,2005-2006

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Rationale for study

High smoking rates in Armenia and India.

No other comparative study conducted for these two countries

Finding common and different risk factors and protective factors associated with tobacco use between the two cities will inform and strengthen tobacco control programs.

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Research question: 1 What are the differences and

similarities between smoking practices, beliefs and attitudes of school- based students 11 to 17 years of age in Yerevan, Armenia and New Delhi, India ?

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Research question: 2 What are the differences and

similarities between students’ familial and environmental factors influencing smoking among youth in school 11 to 17 years of age between Yerevan, Armenia and New Delhi, India?

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Research question: 3 What are the differences and

similarities in risk factors associated with initiation of smoking among youth in school 11 to 17 years of age between Yerevan, Armenia and New Delhi, India?

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Global Youth Tobacco Survey (GYTS)

School-based surveys conducted globallyCollected data from students13 to 15

years of ageUsed standardized methodology to

construct sampling frame, randomized methods to select schools and classes for sampling and data processing

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MethodsSecondary data analysis

Datasets and codebooks

GYTS 2001 New Delhi, India (N=12086)

GYTS 2004 Yerevan, Armenia (N=560)

Sources

WHO website

Coordinator of the state tobacco control

program in Armenia 11

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•Data analysis

•SPSS 11 software

•Code book of 32 questions created

•69 questions for India

•91 questions for Armenia

Methods

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Results: Bivariate analysis Variable Yerevan

N=560New Delhi N=12,086

P -value

GenderBoysGirls

45.7%54.3%

58.0%42.0% <0.001

Smoking statusRegular Smokers

Experimenters4.1%27.0%

5.1%16.0% <0.001

At least one parent smokes

68.6% 41.1% <0.001

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Regular smoking prevalence rate by gender and city

Yerevan New Delhi0

1

2

3

4

5

6

7

8

9

10

girlboy

%

P<0.001

Percent

Regular smoking prevalence rates among student by age group, stratified by city

P<0.001

11 to 13 14 to 15 16 to 170

2

4

6

8

10

12

YerevanNew Delhi

%

%

%

%

%

Age Groups in Years

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Percentage of students who reported definitely or probably smoke or not smoke a cigarette if their best friend offered them a cigarette

P<0.001

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Final multivariate logistic regression with city of residence (New Delhi vs. Yerevan) as the outcome and smoking risk factors as covariates

Variable Odds ratio P value

Age 0.90 0.043

Male participants 2.37 <0.001

Father smoker 0.50 <0.001

Would smoke, if best friend offers a cigarette to smoke 0.05 <0.001

Family member discussed harmful effects of smoking 3.560 <0.001

Many vs. few/none anti-smoking references seen on posters 1.90 <0.001

Many vs. few/none anti-smoking references encountered in newspapers and magazines 4.06 <0.001

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Final multivariate logistic regression with regular smoking vs. non-regular smoking as the outcome, city of residence (New Delhi vs. Yerevan) and smoking risk factors as covariates

Variable Odds ratio P value

Age 1.27 <0.001

Male participants 2.62 <0.001

Father smoker 1.29 0.018

Would smoke, if best friend offers a cigarette to smoke 11.01 <0.001

Family member discussed about the harmful effects of smoking 0.70 0.001

Many vs. few/none anti-smoking references seen on posters 0.57 <0.001

Many vs. few/none anti-smoking references encountered in newspapers and magazines 0.76 0.029

City (0 = Yerevan, 1= New Delhi) 7.42 <0.001

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DiscussionFemale students more likely to take up

regular smoking in New Delhi than in Yerevan

Regular smoking rates were higher in the earlier ages in New Delhi and were higher in later ages in Yerevan.

Rates of increase in smoking rates over age higher in Yerevan than Delhi.

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DiscussionFathers almost twice as likely to be

smokers in Yerevan than in New Delhi.Students in Yerevan twenty times more

likely to accept and smoke a cigarette offered by their best friend than in New Delhi.

Anti-smoking references seen on posters and in newspapers and magazines were more frequently seen by non-regular smokers than regular smokers.

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Limitations

There were too few girls who smoked to analyze them separately from boys

Because of lack of matches between the instruments, some questions were dropped out

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Strengths

Large sample size of New Delhi and adequate sample size of Yerevan

Surveys conducted only three year apart (2001 and 2004).

Surveys conducted prior to law banning tobacco advertising in both the cities.

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Conclusions

Smoking fathers and peer pressure are associated with increased risk of student smoking.

Family members discussing harmful effects of tobacco is substantially associated with reduced risk of smoking.

Unknown and unmeasured cultural and environmental factors different between the two cities associated with smoking

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RecommendationsSmoking fathers and peer pressure in Armenia

should be especially targeted for more effective anti-tobacco campaign

Family members included in anti-smoking programs to prepare them to discuss harmful effects of smoking.

More comparative studies needed to further explore unknown and unmeasured cultural/environmental factors.

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Դեռահասների շրջանում ծխախոտի

օգտագործման համեմատությունը

( ) Երևանում Հայաստան և ՆորԴելիում

( ) Հնդկաստան

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ԱՌԱՋԱՐԿՈՒԹՅՈՒՆՆԵՐ Դեռահասների շրջանում հակածխախոտային ծրագրերը

ավելի արդյունավետ դարձնելու նպատակով

`առաջարկում ենք

առանձնահատուկ ուշադրություն դարձնել այնպիսի

, գործոնների ինչպիսինն են հոր ծխելը և

հասակակիցների ճնշումը

` ընդգրկել ընտանիքի անդամներին ուսուցանելու

նրանց քննարկել դեռահասների հետ ծխախոտի

օգտագործման վնասակար ազդեցությունները

Ի րականացնել հետագա համեմատական

` հետազոտություններ ուսումնասիրելու դեռևս

չբացահայտված և չգնահատված մշակութային

գործոնների ազդեցությունը դեռահասների

շրջանում ծխախոտի օգտագործման վրա

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Thank You

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Questions?