This study estimated the prevalence of smoking among male urban adolescents and young adults in Bangladesh. It examined the association between the smoking behaviour of young people, and the behaviour and status of their families and peers. The study also investigated whether education institutional promotion of the harmful effects of smoking affected the smoking status of the study population. The findings on smoking prevalence among urban adolescents and young adults are similar to those of earlier studies conducted in Bangladesh and other similar developing countries. The prevalence of smoking among the college students included in this study corresponds to the rate of the study by Tarafdar [24] where students in a higher secondary college in the Moulvibazar district of Bangladesh were the study participants. In another study of college students studying in private and public colleges in three towns of Karachi, Pakistan, [27, 28] it was 24 per cent. Kamal [23] surveyed 474 male students at the Islamic University, Kushtia, Bangladesh, and reported that about 36 per cent were current smokers. It should be noted that, as in our case, many studies only included male students in the target population since smoking prevalence is not high among female students in many low-middle income countries.
Several studies have linked the smoking behaviour of youth with the smoking behaviour of their parents. For example, Gilman and co-authors [5] studied the influence of parental smoking on adolescent smoking initiation. The results indicated that adolescents whose parents were regular smokers had a higher likelihood of being initiated into smoking (OR = 2.81) than adolescents whose parents never smoked. It is well established in the literature that paternal and family members’ smoking status influences youth smoking behaviour [29, 30]. Our study also shares a similar view.
Students living with parents or siblings smoking were more likely to be initiated into smoking at an early age than are those who live in a non-smoking home environment. Parents who hold strong anti-smoking views may directly influence their adolescent children’s intention to smoke and to socialise with smokers [29]. Karimy et al. [31] used demographic variables, psychological factors, and components of the theory of planned behaviour to identify factors contributing to cigarette smoking among male adolescents in Iran. They found that parents’ smoking had a significant impact on the smoking behaviour of adolescents. Our research showed that the average number of smokers in a family was higher for respondents who were current smokers. This study further revealed that the probability of smoking among young people was positively related to their number of smoker friends. It also found that an offer to smoke by friends increased the chance of becoming a smoker.
This study found that most of the current smokers reported being offered a cigarette as the trigger for their initiation into smoking. Peer smoking has emerged as one of the most significant predictors of adolescent smoking in many studies. For example, Christophi et al. [32] showed that smoking by peers was the main predictor of smoking among adolescent students attending middle and high schools in Cyprus.
We found that parental education did not significantly reduce smoking among young adolescents and adults. This is similar to the findings in Kamal et al. [23], where the authors investigated socio-psychological correlates of smoking among male students in selected Bangladeshi universities. The findings of a study conducted in Kerala, India also suggested that the father’s educational attainment had no bearing on adolescent boys’ smoking status [33].
This study found that obtaining knowledge about the harmful effects of smoking from the education provider does not significantly reduce the probability of smoking. The finding differs from those made in some other studies [34]. One reason for this could be that the level of knowledge sharing by the institutions is not intensive enough to be associated with a change in smoking behaviour. Another reason could be that the benefits of smoking are certain as well as immediate, while the costs are perceived to be uncertain and, if they are realised, occur a long way into the future. The place of residence was not found to be a strong factor in our study, which is similar to the findings of a Nepalese study that investigated correlates of use among junior college students in twin cities of western Nepal [34]. In this study, financial support from family was not associated with either the prevalence or intensity of smoking. This is consistent with the finding from Mall Leinsalu’s study in Hungary in terms of self-generated income [35].
Our study has a few limitations. One of the limitations of the study is that biometric screening was not done to confirm the smoking status of the individuals. Therefore, there might exist some under-reporting or over-reporting, which is a common limitation of self-reported data. The present study tried to minimise this effect by employing a well-trained interviewer who was likely to convince the respondents that confidentiality would be strictly maintained. The modelling approach adopted in this study could lend itself to different kinds of interpretation. However, the coefficients of interest are not sensitive to the choice of variables, as depicted in supplementary Table 1.
This study has a number of policy implications for tobacco control in Bangladesh. First, most of the tobacco control law focuses on tobacco advertising and promotion, health warning messages and smoke-free public places. Bangladesh government is also exploring tax-raising policies to control tobacco use. However, little to no attention has been paid to prevention campaigns that involve parents or campaigns aimed at teaching young and adolescents peer refusal skill. Second, Bangladesh also lacks cessation interventions targeting adult smokers specially smoker parents. Quitting helpline and tobacco treatment interventions are also unavailable in Bangladesh. Third, studies have found that family engagement and family cohesion on anti-smoking behaviour reduce smoking among adolescents and young adults [36, 37] and in line with our findings, we suggest that Bangladesh government could design interventions aimed at parents and educational institutions. While not covered in this study, smoke-free air law initiatives have been successful in other countries [38] and should be initiated as a potentially successful intervention in Bangladesh, for example, introducing smoke-free campuses in educational institutions. Future research on designing family and peer intervention would benefit Bangladesh on tobacco control.