Tobacco use and exposure to tobacco promoting and restraining factors among adolescents in a developing country.
OBJECTIVE
With a long history of tobacco cultivation, adolescents in Ghana are at relatively high risk of the emerging tobacco epidemic in developing countries. This study explored exposure to tobacco promoting/restraining factors and their associations with smoking and tawa (traditional smokeless tobacco) use among 13-18-year-old Ghanaians.


METHODS
School-based representative data were collected in 2008 (n = 1165).


RESULTS
Prevalence rates of tobacco use, smoking and tawa use were 9.1% (11.5% boys and 6.4% girls), 6.6% (8.0% boys and 4.7% girls) and 5.7% (7.3% boys and 3.9% girls), respectively. Four percent of the respondents attended schools without a smoking ban, 66% had been taught about the harmful effects of smoking in the current school year, and 53% had been exposed to tobacco advertising. Fifty-three percent of adolescents who had tried to purchase tobacco products were not refused because of their age. Multivariate analyses found that attendance at a school where smoking was allowed, not having been taught about the harmful effects of smoking, exposure to tobacco advertising and parental smoking were positively associated with tobacco use, and knowledge that smoking is harmful to health and difficult to quit were negatively associated with tobacco use.


CONCLUSIONS
Both smoking and tawa use were relatively low among Ghanaian adolescents. Exposure to tobacco advertising was high. There is no tobacco legislation in Ghana, but societal norms or cultural values seem to restrict smoking in schools and access to tobacco products.
Department of Population and Health, Faculty of Social Sciences, University of Cape Coast, University Post Office, Cape Coast, Ghana. dokudavid@gmail.com
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D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D000329:Advertising; D003466:Cultural Characteristics; D003906:Developing Countries; D005260:Female; D005869:Ghana / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010287:Parent-Child Relations; D015995:Prevalence; D011640:Public Policy; D012574:Schools; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology*