Factors associated with smoking among adult males, Sri Lanka- A cross sectional analytical study

Abstract

Background and Objectives Studies in developing and developed countries have assessed only a limited number of factors for their association with smoking. However, the literature indicates that factors are better assessed using a comprehensive model (PRECEDE) to identify predisposing, reinforcing and enabling factors which initiate and maintain the smoking behaviour. This study aimed to determine the factors associated with smoking based on the PRECEDE model Methods The two groups of ever smoker (n=624) and never smoker (n=530) males aged 20-59 years were identified in a community based household survey in the Colombo District of Sri Lanka. Post hoc sample size estimation indicated a power of 82% for the smallest factor which showed a significant association. The information on predisposing, reinforcing and enabling factors associated with smoking was gathered using an interviewer-administered questionnaire designed using on the PRECEDE model. Results Age more than 40 years (p<0.01), a low educational level (p<0.001), being married (p=0.002) or unemployed (p<0.01) and unfavourable attitudes that promote smoking (p=<0.001) were found to be significant predisposing factors associated with smoking. Paternal smoking (p<0.001), having a family member who smokes (p=0.004), having a close friend who smokes regularly (p<0.001), being offered tobacco products (p<0.001) and getting frequent invitations to parties where friends smoke (p<0.001) were factors that reinforced the smoking habit of adult males when they were younger. Enabling factors assessed among ever smokers indicated that a majority (92%) who started smoking at a younger age had bought the tobacco products themselves and 13.4% have bought the tobacco products as packets while 91.4% have bought them as single/multiple sticks. Most of the ever smokers (93.7%) stated that there was a place to buy tobacco products near their house/ school/ work place. Conclusions Factors that were found to be associated with smoking among adult males in Sri Lanka were mostly modifiable. The study recommends comprehensive intervention programs to prevent smoking, targeting adult males and addressing the modifiable factors.