A survey was conducted in 2008 on health behaviours and lifestyles of youth in Junior and Senior High schools in two out of the three zones in Ghana.
Sample
Thirty schools were randomly sampled in three regions, ten per region, from Eastern (total number of schools in the region = 2924), Greater Accra (total number of schools in the region = 1825) and Volta Regions (total number of schools in the region = 2184). The present study involves youth aged 12-20-year-old students (N = 1338). The sampling was done as follows: First, ten schools were randomly selected so that they comprise of four public Junior High Schools, two private Junior High Schools, three public Senior High Schools and one private Senior High School in each region in order to reflect the school types in Ghana. Second, in each school, all students whose names were found in the class attendance register of the randomly selected classes were eligible to participate in the survey, after the purpose of the studies was explained to the entire class. The final sample size was 1556, which represented a response rate of 89.7%. The reason for non-response was that pupils were absent from school on the day of data collection. Boys comprised approximately 46% of the sample size.
Data collection
The eight page questionnaire was anonymous and self-administered and was tested with an initial pilot sample of 50 children in three schools. It was designed to exclude any information that will reveal the identity of the participants. To ensure confidentiality, no teacher was present in the classrooms during the survey. One trained supervisor from the research team was assigned to each classroom during the answering. To prevent contamination, the survey commenced simultaneously in all the participating classes in a given school. Participants were asked to drop their questionnaires in an envelope placed in front of the class on completion. The purpose of the survey was again explained to the randomly sampled adolescents, and they were given the right to accept or decline participation. Furthermore, written informed consents were obtained from 18-year-old adolescents and parents of those under 18 years old who voluntarily agreed to participate in the study.
The study protocol was approved by the ethical committee of the Ghana Health Service Research Unit in Accra, Ghana.
Measures
Intention to smoke was measured by the question: “At any time during the next one year (12 months) do you believe you will smoke a cigarette?” The responses were “Definitely not”, “Probably not”, “Probably yes” and “Definitely yes”. For the analyses, this measure was categorized into two: “No” (definitely not, probably not) and “Yes” (probably yes, definitely yes).
Smoking was assessed by the question: “Have you ever tried cigarettes or any other tobacco product?” The response options were “No” and “Yes, which product….”. In this study smokers refer to those who answered “Yes” to the above question (excluding those who mentioned smokeless tobacco product).
Environmental and familial tobacco promoting/restraining factors
Smoking on school compound. Respondents were asked whether smoking was allowed on their school compound or not. The response options were, “yes”, “no” or “I don’t know”.
Taught the harmful effects of smoking. Two separate questions were used to assess whether adolescents were taught the harmful effects of smoking in school during the present school year and whether any family member had discussed the harmful effects of smoking with them with the response options “yes/no”.
Refused cigarette sale due to age. Respondents indicated “yes” or “no” regarding whether or not they had ever been refused cigarette sale due to their age.
Exposure to tobacco advertisement. Respondents indicated whether they had seen any tobacco advertisement during the past month from the following options: billboard, cigarette car/van, newspaper, television, internet/email or other sources.
Parental smoking. In two separate questions adolescents were asked to indicate whether their fathers or mothers smoke at present, had never smoked, had smoked but had stopped, whether they couldn’t say anything about parental smoking or had no father or mother. Parental smoking was classified into three categories of “none”, “can’t say” and “one or both parents smoke”.
Knowledge and attitude indicators
Adolescents indicated whether they completely agree, slightly agree, completely disagree, slightly disagree or were not sure about the following statements: “Smoking is harmful to one’s health”, “Tobacco products should not be sold to those less than 18 years of age” and “Smoking is difficult to quit once started”. The responses were categorised as “agree” (completely agree, slightly agree) and “disagree/not sure” (slightly disagree, completely disagree, not sure).
Statistical analysis
Pearson’s Chi-square tests (two-tailed p-values at a statistical significance level of p < 0.05) were used to test the statistical significance of the relations between the studied variables and smoking intentions. Adolescents with incomplete responses were excluded from the analyses. The frequency of missing values for the explanatory variables varied from 3.3 and 6.2%, except for parental smoking which had 16.6% missing values. Factors associated with smoking intentions were studied using logistic regression analyses. First, bivariate analyses were computed (Model 1) for each of the explanatory variables, adjusting for age and gender. Second, in a multivariate model, the independent associations of all the factors that were statistically significant at the bivariate level were studied, adjusting for age and gender (Model 2). In additional to the total sample, stratified analyses were conducted for never smokers. The results were given as odds ratios (OR) and 95% confidence intervals (CI). SPSS package, version 16 (SPSS Inc, Chicago, Illinois) was used for the analyses.