Smoking, addiction and promotion - an inquiry into perceptions of a group of adolescents in the Kandy Education Zone

Introduction: Tobacco companies take vigorous action to promote smoking and to sustain the habit among young people. The companies mainly target students as they are in their formative stages of learning. Strong messages can influence their opinions leading to change in behavior. Objectives: To describe the attitudes regarding smoking among the students, their awareness regarding promotional strategies of tobacco companies and to identify the methods of acquiring knowledge regarding these strategies among Grade 12 students in the Kandy Educational Zone. Method: A descriptive cross sectional study was carried out. A multi stage cluster sampling method was adopted to select the study sample of 204. A pre-tested, self-administered questionnaire was used as the study instrument. • Results: More than 80% of both sexes perceived smoking as a negative social characteristic. Majority of the students (91.6%) thought that smokers have got addicted to it due to the lack of proper understanding. Awareness among, the students about the indirect promotional strategies of the tobacco companies was satisfactory as 47% of students knew about them. However, 41% had poor or very poor knowledge regarding these strategies. Mass media was shown to be a major source of acquiring knowledge on tobacco promotional strategies. Only one third of the students who participated in the study have been exposed to seminars/ workshops conducted by anti narcotic organizations. Conclusion: Students of our study population perceived smoking as a negative social characteristic. However, their knowledge regarding promotional strategies of tobacco companies needs improvement. Main mode of acquiring knowledge regarding promotional strategies was identified as mass media. The few who were exposed to seminars conducted by anti narcotic organizations were shown to have a significantly higher level of understanding on these strategies than the others.


Introduction -
"In every 10 seconds one dies due to the effects of smoking somewhere in the world" (1).
Smoking poses an immense threat to the well being of the people, economy of the country, environment and ultimately the development of the country. The money spent on tobacco .by poor families in developing countries is enormous. Vast number of diseases including heart diseases, stroke, cancers and respiratory diseases are linked to tobacco use. It harms the non-smokers equally. The indirect impact on poor is much severe than the direct results caused by use of tobacco (2).
In many developed nations tobacco use is falling, due to effective public health campaigning and due to successful tobacco control programmes. These include increase in price through taxation, increase in restrictions in advertising and sponsorship and enforcement of restrictions on smoking in public and work places (3). To balance the loss of profits from the developed nations, the multinational tobacco companies concentrate more on developing countries by aggressively promoting their products. As a consequence, prevalence of smoking in countries like ours is increasing (4).
Tobacco companies take vigorous action to promote smoking and to sustain the habit among young people by using compelling advertisements, in the print and electronic media (5). Furthermore, they use very effective methods to promote tobacco, by showing it as glamorous and enjoyable, sponsoring sports events, organizing competitions, promoting their company logo which creates a positive image on smoking (6). The importance of this is that the companies target students as they are in their formative stages of learning. Strong messages can influence their opinions leading to change in behavior. As the companies use their promotional campaigns in a subtle manner, the uninformed students perceive the tobacco company projected image as the socially correct behavior to follow.
A research study conducted by Alcohol and Drug Information Centre (ADIC) in July 1998 showed an overall prevalence of smoking in selected districts of Sri Lanka as 41% and nearly 72% of this was among the age grou p 16-40yrs(7).

Objectives
To describe the attitudes on smoking and knowledge regarding tobacco promotional strategies among year 12 students of the Kandy Educational Zone.
The specific objectives were to describe the attitudes regarding smoking among the students and their awareness regarding promotional strategies of tobacco companies and to identify the methods of acquiring knowledge regarding these strategies.

Methods
A descriptive cross sectional study was carried out among students in Grade 12 in the Kandy Educational Zone. A multi stage cluster sampling method was adopted to select the study sample of 204. All the students who were present on the day of the study and who were willing to participate were included in the study. A pre-tested, selfadministered questionnaire was used as the study instrument. Most of the questions were close ended for the convenience of the respondents.
Questionnaire consisted of three parts.

. Samarasekera
On analysis of the students attitudes regarding why people get addicted to smoking, majority said that it is due to lack of proper understanding. Only 27% said that it is the effect of seeing tobacco use in films (Table 2 When the final analysis was done, it was found that 49% of boys and 43% of girls knowledge is in the satisfactory category. However, 37% of boys and 49% of girls knowledge is in the poor/very poor category. (Table 3) The knowledge regarding indirect promotional strategies of the tobacco companies among girls and boys did not show a statistically significant difference.

Part 3. Ways of acquiring knowledge, which helped in answering the questionnaire
Most of the students (80%) acquired the knowledge regarding indirect promotional strategies of the tobacco companies by the mass media.  "Other methods were: By being in the society -9.4%, Parents and teachers -7.4%, Personal experiences -3.4%, Close friends -3.4%, Internet -0.5 %

Discussion
The problem of smoking among young adults is growing day by day and we need to take very drastic antipromotional action to control this menace (4). Such action should specially target the children as tobacco companies are mainly targeting the children. Preventing young people from starting the habit would cut the number of deaths related to tobacco.
A study done on prevalence of smoking in a rural community in Sri Lanka showed a significantly higher prevalence of smoking among the uneducated than the educated. According to this study, 20.6% were smokers in the total population (9).
A satisfactory finding in our study was that more than 80% of students of both sexes perceived smoking as a negative social characteristic. However, only 67.1% of the girls thought that smoking is a silly thing while 96.3% of boys thought so and this difference is statistically significant. Also, the percentage of girls who think that smoking is an alternative method to stand out in a crowd is significantly higher than in the boys; this may be due to the image that has been promoted by the tobacco companies.
Another study on "Effect of seeing tobacco use in films on trying smoking among adolescents" showed a strong, direct and independent association between seeing tobacco use in films and trying cigarettes (10).
Majority of the students of our study sample (91.6%) thought that the smokers have got addicted to it due to the lack of proper understanding and only 26.9% said it is because actors/actresses smoke. In our study 85.8% were not aware that advertising specially targets girls. Majority of the students were also not aware about the following: The tobacco companies spend millions of money to prepare false research reports, they use their supportive groups to criticize and challenge the existing scientific data, they pay millions to certain scientists and get them to prepare false reports challenging the scientifically proven direct relationship between smoking and lung cancer and they use ladies in short dresses in public places called 'golden girls' to promote cigarettes (8).
Our survey also showed that students awareness about indirect promotional strategies of the tobacco companies was satisfactory as 47% of them could correctly answer more than 50% of the questions on indirect promotional strategies used by tobacco companies. At the same time 41% had poor or very poor knowledge regarding these indirect promotional strategies.
On further analysis, mass media was shown to be a major source of acquiring knowledge on tobacco promotional strategies and only one third of the students have been exposed to seminars/workshops conducted by anti-narcotic organizations as a way of acquiring knowledge. Importantly, those who had participated were shown to have a significantly higher level of understanding on the strategies of tobacco companies to promote their products than those who had not participated in such activities.
The limitation of our study was the small sample size since we restricted our study to one educational zone.

Conclusion
Ninety percent of the students of our study population perceived smoking as a negative social characteristic. However, their knowledge regarding promotional strategies of tobacco companies was inadequate. Main mode of acquiring knowledge regarding these promotional strategies was identified as the mass media. Although, the seminars/workshops conducted by organizations dedicated to prevention of substance abuse are a less popular method of acquiring knowledge among students, the knowledge of those who participated was significantly high. We recommend extending such programmes island wide with more interactive sessions.