Susceptibility to Smoking among Non-smoking East-Asian Youth: A Multilevel Analysis

Objective - Among non-smoking youth in east-Asia, to estimate the extent to which susceptibility to smoking is associated with between-context differences (schools and classes) and to identify factors at school, class and individual levels that influence individual susceptibility to smoking. Methods - Cross-sectional data from the Global Youth Tobacco Survey conducted in Cambodia (2002), Laos (2003) and Vietnam (2003) are used to conduct multilevel analyses that account for the nesting of students in classes and classes in schools. The outcome variable is smoking susceptibility, defined as the absence of a firm decision not to smoke and measured using a validated algorithm. Explanatory variables include school and class level influences (current tobacco use prevalence in school, exposure to anti-smoking media messages, exposure to tobacco billboard advertising and school prevention) and individual level influences (parent and friends smoking behaviour, knowledge of the harmful effects of and exposure to second-hand smoke at home, age, sex and pocket income). Results - Multilevel analyses indicate that about 10 percent of the variation in smoking susceptibility is associated with school and class differences. Teens who have parents or friends who smoke, who are exposed to second-hand smoke at home and those who have access to pocket income are found to be more susceptible while better knowledge of the harmful effects of second-hand smoke appears to diminish susceptibility to smoking. For girls only, billboard tobacco advertising increases the risk for susceptibility and school prevention decreases risk while for boys only, attendance to schools with higher prevalence of tobacco use increases risk for susceptibility and anti-smoking media messages decreases risk. Conclusions - This study highlights a number of modifiable factors associated with smoking susceptibility and identifies interactions between teen sex and several factors associated with the susceptibility to smoking. This finding provides support to the call to move beyond genderblind tobacco control policies.