Prevalence and risk factors of smoking among secondary school students in Nairobi.
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OBJECTIVES: To determine the prevalence of smoking and investigate factors that may influence smoking behaviour in secondary school students in Nairobi. DESIGN: Cross-sectional survey in which a self-administered questionnaire was issued to the students. SETTING: Sampled public and private secondary schools in Nairobi. PARTICIPANTS: All the students in the selected secondary schools were included in the study. RESULTS: Five thousand, three hundred and eleven (74.1%) secondary school students were covered. There were 3658 boys and 1653 girls in the study. The mean age was 16.7 years SD +/- 1.48. The study covered 3065 (77.3%) and 2246 (70.1%) of the public and private school students respectively. A total of 1709 (32.2%) were ever-smokers. The overall rate of ever-smoking by gender among the students was 38.6% of males and 17.9% of the females. Experimentation with smoking started at five years and regular smoking at 10 years but majority of students (72.2%) started at between age 12 and 16 years. Parents' and teachers' smoking habits influenced initiation of smoking by young children while peer pressure, advertising and type of school influenced older children to smoking. About 67% of the ever-smokers stopped the habit giving various reasons. There was a strong relationship between age of smoking initiation and stoppage. Majority of the students smoked either to enhance their personalities or for stimulation. Most students smoked less than five cigarettes per day. General shops, kiosks and cigarette stalls which sell cigarettes in both packets and single sticks were the main source to students. Students smoked mostly in the evening and at night. Most student smokers were not discouraged by health warnings on the cigarette packets and awareness of the dangers of smoking. Enforceable legislation that would ban advertising and make smoking illegal was the main recommendation from the students. CONCLUSIONS: Smoking is a problem among Kenyan students. The habit starts quite early in life. Peer pressure, advertising, type of school and age influenced smoking among the students. Banning the sale of cigarettes in single sticks is recommended. Anti-smoking campaigners and specially trained school teachers should encourage attitude shaping among school children towards self confidence and adequacy.