- EQUAL CONTRIBUTIONS
O.F. Fagbule1,2, K.K. Kanmodi2,3,4, V.O. Samuel 2,5, T.O. Isola2, E.O. Aliemeke2, M.E. Ogbeide2,6, K.E. Ogunniyi2,7, L.A. Nnyanzi4, H.O. Adewuyi2,8, F.B. Lawal1, O. Ibiyemi1
- Department of Periodontology and Community Dentistry, University of Ibadan and University College Hospital, Ibadan, Oyo State, Nigeria.
- Cephas Health Research Initiative Inc, Ibadan, Oyo State, Nigeria.
- Medical Research Unit, Adonai Hospital, Karu, Nigeria
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
- Department of Pharmacology and Therapeutics, Ahmadu Bello University, Zaria, Kaduna State, Nigeria.
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Sokoto State, Nigeria.
- Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria.
- Department of Guidance and Counseling, Faculty of Education, University of Ibadan, Oyo State, Nigeria.
Background: Cigarette and alcohol use are the most common causes of noncommunicable diseases. Studies related to cigarette and alcohol use among Nigerian adolescents have shown increases in the habits and require urgent intervention. Nationally representative data is needed to develop effective national policies and interventions, but this is lacking. Hence, this study aimed to provide nationally representative empiric information about cigarette and alcohol use prevalence and predictors among Nigerian secondary school students.
Methods: This study included 2,530 Nigerian students in Nigeria from five of the six geopolitical zones in Nigeria. A self-administered questionnaire was used to obtain information about the participants’ sociodemographic and school-based characteristics, cigarette and alcohol use status, and harm perception of tobacco and alcohol use. Data were analysed with SPSS version 25 at p<0.05.
Results: Participants’ mean age (±SD) was 16.34 (±2.0) years. The prevalences (95%CI) for ever-cigarette and current-cigarette smoking were 11.1% (95%CI:9.9- 12.4) and 8.4% (95%CI:7.3-9.5), respectively. While 21.0% (95%CI:19.4-22.7) and 15.6% (14.2-17.1) were the prevalences for lifetime and current alcohol use, respectively. The predictors of current cigarette smoking were studying in northern Nigeria (aOR:1.94;95%CI:1.10–3.44), attending private-schools (aOR:1.56;95%CI:1. 03–2.38), boarding-student (aOR:1.75;95% CI:1.15–2.69), male-gender (aOR:3.03; 95%CI:1.80–5.10), current alcohol use (aOR:12.50;95%CI:8.70–18.18), having no (aOR:2.59;95%CI:1.58–4.26) or low tobacco harm perception (aOR:2.04;95%CI:1.18– 3.53). The predictors of current alcohol use were male (aOR:1.32; 95%CI:1.01– 1.72) and current cigarette smoking (aOR:12.5;95%CI:8.77–17.86).
Conclusion: The prevalences of cigarette and alcohol use were high among Nigerian secondary school students, and both habits were strongly associated. Their predictors were school-related factors, sociocultural characteristics, and tobacco harm perception.
Keywords: Tobacco, Substance use, Head and neck cancer, Adolescents, Africa
Dr. O.F. Fagbule
Dept of Periodontology and
University of Ibadan,
Oyo State, Nigeria
Cigarettes and alcohol are major sources of public health concern, affecting all countries worldwide. About 1.1 billion are current tobacco users, while 2.3 billion people are drinking alcohol.1,2 They are addictive and pose serious health risks such as cardiovascular diseases, neurological problems, and different types of cancers, including head and neck cancers (HNC).1,3 While they can individually cause these health problems, combining the two habits has a synergistic effect and substantially increases the risks,4 and doing so during adolescence presents even greater health risks.3,5
Considering that most adult cigarette and alcohol users commence during adolescence,1,3,6,7 it is important that effective interventions prevent these vulnerable populations from initiating the habits and quitting if they have started. These interventions should address the factors associated with the habits among youths and adolescents. Some of the associated factors include social factors (peer and parental influence, low socioeconomic status), psychological factors (mental health problems, impulsivity, self-esteem), and low harm perception associated with these habits.1,3,7–10
Several studies on cigarette and alcohol use among Nigerian secondary school students have recorded varying prevalences.10–14 However, a general trend is that the practices have increased in the last decade and are now public health problems requiring urgent interventions.10–14 Although different studies have assessed factors influencing cigarette and alcohol use among secondary school students in different parts of Nigeria, most are limited to small communities and cities, thus, limiting their generalizability. Nationally representative data about this vulnerable population is needed to develop effective national policies and interventions, which are currently lacking.
Hence, this study aimed to provide nationally representative empiric information on the prevalence of cigarette and alcohol use and factors (sociodemographic, school-based characteristics, and harm perceptions) predicting both habits among secondary school students in Nigeria.
This study was a descriptive cross-sectional survey of secondary school students in Nigeria.
Study area and population
Nigeria is the most populous black nation, with an estimated population of over 200 million people.15 The country also has one of the highest proportions of adolescents globally, with an estimated 22% of the total population. 15 Nigeria is divided into six geopolitical zones: North-East, North-West, North Central (making up the northern region), and SouthWest, South-South, and South-East (making up the southern region).16 Nigeria has 36 states and the Federal Capital Territory (FCT).16 The secondary schools comprise six classes (three junior classes – JSS1-3 and three senior classes SSS1-3). The schools are either government-owned (public schools) or owned by private individuals or institutions (private schools). Most of the schools have both gender (mixed schools), but a significant proportion of the schools are single gender based (girls-only and boys-only). The official age of entry into the JSS 1 class is 12 years17,18, although many students get into this class at younger ages (9-11 years) by either enrolling in the basic schools early or skipping some classes in the primary schools.18
Ethical approval to conduct this study was obtained from the University of Ibadan/University College Hospital Ethical Review Board (Ref: UI/EC/18/ 0077). Permission was also obtained from the participating schools’ principals. Parental informed consent was obtained from the parents/guardians of the selected participants, after which the students also assented to participate in the study.
The study instrument was a self-administered semi structured questionnaire developed by reviewing relevant literature on tobacco and alcohol use among adolescents.10,12,19 The questionnaire was then revised by tobacco control experts and subsequently pretested among conveniently selected secondary school students who were not part of those selected for the study.
The questionnaire was used to obtain information about the participants’ sociocultural characteristics (age, gender, tribe, religion, and family background); schoolrelated characteristics (school location – northern vs southern Nigeria, ownership – private vs public, setup – boys-only vs girls-only vs mixed, mode of the studentship – day vs boarding, classes – SSS 1-3). Others were participants’ tobacco harm perception, cigarette and alcohol use status.
The cigarette smoking status was assessed using the question: “are you currently smoking cigarettes?” and the options were “No, I have never smoked”, “No, I have quit smoking”, “Yes, but I am trying to quit” and “Yes, not trying to quit”. Based on their responses, those who chose “No, I have never smoked” were categorised as “Never smokers” while others were termed “Ever smokers”. Furthermore, those who chose “Yes, but I am trying to quit” and “Yes, not trying to quit” were categorised as “Current smokers”.
Similarly, alcohol use status was assessed with the question: “Are you currently drinking alcohol?” and the options were “No, I have never drunk alcohol”, “No, I have stopped drinking”, “Yes, but I am trying to quit drinking” and “Yes, not trying to quit”. Based on their responses, those who chose “No, I have never drunk alcohol” were categorised as having “No lifetime history of drinking alcohol”. Others were classified as having a “lifetime history of alcohol use”. Those who chose “Yes, but I am trying to quit” and “Yes, not trying to quit” were categorised as “current alcohol users”.
Tobacco harm perception was assessed with the question: “Tobacco use can cause head and neck cancer”, and the responses were “Definitely yes”, “Probably yes”, “Probably not”, and “Definitely not”. The participants were classified as having “High”, “Moderate”, “Low”, and “No” harm perception, respectively
The multistage sampling technique was employed for this study. The first stage involved the selection of five geopolitical zones (North-East, North-West, North Central, South-West, South-South) from the six zones in Nigeria using the simple random sampling technique. Thirteen schools were subsequently selected from the five zones in the second stage with a minimum of two schools selected from each of the five zones. Finally, all students in SSS1 – 3 classes of the selected schools were recruited for the study.
Data were collected from Oyo, Edo, Bauchi, Sokoto, Osun, and Benue states between November 2016 to January 2018. A total of 3,000 SS1–3 students were approached in the selected schools, but 2,754 (91.8%) students agreed to participate in the study. Written parental informed consent and assent were obtained from all consenting students before participating in the study. All 2,754 selected participants were given a questionnaire to fill out, but 2,701 participants (98.1%) returned theirs. The filled questionnaires were screened for completeness and appropriateness of responses, and 171 questionnaires were discarded because they were not appropriately filled, leaving 2,530 (93.7%) that were analysed.
Data from 2,530 filled questionnaires were analysed using SPSS version 25 software. Current cigarette smoking and alcohol use were the primary outcome variables, while sociodemographic and school-related characteristics, tobacco harm perception, lifetime history of alcohol and cigarette use were explanatory variables. The frequency distributions of all variables were determined. Pearson’s Chi-square tests were conducted to assess the association between current cigarette and alcohol use and the categorical independent variables (sex, religion, family background, tribe, school location and ownership, mode of studentship, class level, lifetime history of cigarette and alcohol use, tobacco harm perception). Independent Samples t-test was also conducted to assess their association with the continuous variable (age). Factors that were significantly associated with current cigarette smoking and current alcohol use at p < 0.05 at bivariate analysis were subsequently included in the Binomial logistic regression modelling for both current cigarette smoking and alcohol use, respectively. The level of statistical significance for all the tests was set at p < 0.05.