Strive-The Student View
February, 2010 edition  

Tobacco Consumption Among Male Teenagers in One Private High School
in the Kingdom of Bahrain

By Aysha Mohammad Ashiq Khan

Tobacco usage has become a common trend among teenagers in developing countries. The Kingdom of Bahrain is experiencing this disturbing trend. Most smokers begin using tobacco products before reaching the age of 18.[1] “It was predicted that if the pattern seen nowadays continued, a lifetime of tobacco use would result in the deaths of 250 million children and young people alive today, most of them in developing countries.”[1]

This article was part of my course work in the third semester of our five-semester program on prevention of oral diseases. The aim of the project was to survey the current usage of tobacco products among students at one secondary school. To find out the average frequency of use, number of students and reason for tobacco consumption among teenagers, a private secondary school was surveyed on Dec. 23, 2008.

Literature Review

Four main types of tobacco products are available in the kingdom: cigarette, waterpipe, cigar and pipe.[2] The World Health Organization (WHO) reported that Bahrain was ranked 15th of 106 countries for cigarette consumption.[3] According to the World Health Report 2002 by WHO, the diseases related to tobacco use are cancers of mouth, pharynx, larynx, esophagus, lung, pancreas and bladder; ischaemic heart disease; hypertension; myocardial degeneration; pulmonary heart disease; other heart diseases; aortic aneurysm; peripheral vascular disease; arteriosclerosis; cerebral vascular disease; chronic bronchitis; emphysema; pulmonary tuberculosis; asthma; pneumonia; peptic ulcer and other respiratory diseases.[4] In the kingdom, tuberculosis is a well-known disease. The WHO statistic for Bahrain was 34 tuberculosis cases per 100,000 populace, with Bahrain being ranked 96th of 165 countries.[3] Lozier and Gonzalez state that, along with the above-mentioned systemic health problems, tobacco can have a direct effect on the oral cavity.[5]

The most recent WHO statistics demonstrate that Bahrain’s population is at a risk of developing any of the above-mentioned diseases relating to tobacco consumption. “Being a male with a smoking friend or family member was shown by multiple regression analysis in our study to be the most predictive factor for being a smoker. In fact, having a smoking friend (peer pressure) has been shown by this study and many others to be consistently linked with smoking of youngsters. A Bahraini study reported that 43% of smokers reported that their best friend was a smoker, compared with 15.4% among non-smokers.”[6]

Methods

A closed-ended 10-item questionnaire was developed for a secondary school survey. A high school was chosen for this pilot study to survey male students only. A total of eight classrooms were assessed: two eighth-grade classes, one 10th-grade class, four 11th-grade classes and one 12th-grade class. In total, 170 male teenage students were asked to complete the questionnaire. The questionnaire assessed age, type of tobacco product used, how often used, how long they had been used, main reason for its usage, awareness of health issues related to the use of tobacco, potential for stopping it at anytime and usage among family members.

Results

One out of five, or 20.59 percent, of the high school students surveyed reported tobacco usage (Table I). Further breakdown of the data shows 71.4 percent of the users smoked cigarettes and 14.3 percent used smokeless tobacco, while the remaining 14.3 percent used both smoking and smokeless tobacco. More than one third, or 34.28 percent, acknowledged daily use; the once-a-week users represented 28.57 percent of the students, and 31.4 percent reported rarely using tobacco. Use of tobacco products increased with the grade level. Approximately 8 percent of the 8th-graders were using tobacco, while over a third, or 36 percent, of the 12th-graders consumed some form of tobacco.

The most common reason for using tobacco products was found to be fashion (social pressure for acceptance, role models; i.e., movie actors using tobacco) while stress reduction (34.28 percent) came in as the second reason (Table II). The third reason was reported as best friends’ smoking (17.14 percent). It should be noted that there is probably a strong overlap of the two categories of best friends’ smoking and fashion. Both indicate a form of social or peer pressure, which can play a most important role in the developing years of teenagers. Interestingly, the data showed that no student smoker felt that any of the family members who smoked had influenced them in the use of tobacco products. It was also found that the students were unaware of any health issues related to tobacco consumption. Table III indicates that approximately 16 percent of the male students have been using tobacco products for well over six years. Tobacco educational information is needed early in the primary grades, as well as in the secondary schools.

Conclusion and Recommendation

Tobacco is harmful to human life. Lack of knowledge regarding the harmful effects can be injurious to all citizens of a country. Prevention strategies should be introduced to educate people, especially teenagers and children. School health tobacco cessation programs can be incorporated into the primary school curriculum in order to inform and educate potential tobacco users.6 Secondary school health programs should be developed to target the current tobacco users for cessation.

Further, it is recommended that public health tobacco cessation programs should be available to all citizens. More research needs to be done in this area of behavior among children and teenagers within the Kingdom of Bahrain.

References

1. World Health Organization. Tobacco free initiative, Youth and Tobacco; 2009. Available at http://www.who.int/tobacco/research/youth/en/index.html.
2. World Health Organization. Tobacco control in Bahrain. East Mediterr Health J 2007; 13(3). Available at http://www.emro.who.int/publications/emhj/1303/article26.htm.
3. Nation Master. Bahraini health statistics, tobacco>cigarette consumption. Available at http://www.nationmaster.com/red/country/ba-bahrain/hea-health&all=1.
4. World Health Organization. Tobacco and health in the developing world; Page. 4. Available at http://ec.europa.eu/health/ph_determinants/life_style/Tobacco/Documents/who_en.pdf.
5. Smoking cessation practices in the dental profession. J Contemp Dent Pract 2009; 10(4). Available at www.thejcdp.com.
6. World Health Organization. Characteristics and risk factors of tobacco consumption among university of Sharjah students. East Mediterr Health J 2005; 13(6). Available at http://www.emro.who.int/Publications/EMHJ/1306/article23.htm.

Aysha Mohammad Ashiq Khan is in her final year of the associate degree dental hygiene program at the College of Health Sciences, Manama, Bahrain. She looks forward to her dental hygiene career and to expanding the current study to include primary schools and secondary schools in the Kingdom of Bahrain.

Faculty mentors for this edition of “Strive” are Paula Parise, RDH, MS, and Claudine Drew, RDH, MS, EdD of the Dental Hygiene Program, College of Health Sciences, Ministry of Health, Kingdom of Bahrain.