Linking data from the Barbados Global Youth Tobacco Survey (1999, 2002, 2007 & 2013) to tobacco regulation policies.

Abstract

연구배경 및 목적 흡연은 만성 질환의 주요 위험 요인이며, 많은 성인 흡연자들이 청소년시기에 처음 흡연을 시작하고 있기 때문에 청소년 흡연은 보건학에서 중요한 이슈이다. 2015년에 15 세 미만인 세계 인구 중 약 20.2 %가 흡연자이다. 바베이도스는 Global Youth Tobacco Survey를 (GYTS) 시행한 최초 국가 중 하나이며 지금까지 네 차례의 조사를 실시하였다. GYTS 시행과 담배 규제 정책 도입의 결과로 바베이도스는 청소년 흡연율이 감소했다. 본 연구의 목적은 1999 년부터 2013 년까지 시행한 네 번의 설문 조사를 통해 바베이도스 청소년의 흡연 추세를 분석하고자 한다. 연구방법 본 연구는 Global Youth Tobacco Survey(1999년, 2002년, 2007년, 2013년)에 참가한 총 4,786명의 청소년을 대상으로 분석을 시행하였다. 종속변수는 현재 흡연 상태와 흡연 의도이고, 독립변수는 야외 및 가정 실내에서의 간접흡연 노출, 미디어를 통한 흡연 장면 노출, 금연 교육 경험, 담배 회사의 로고가 박힌 물건의 소유, 금연을 권고하는 광고에의 노출, 공공 장소에서 금연하는 것에 대한 찬성, 담배 규제 정책 시행 여부 등이 있다. 모든 통계 분석은 SAS 9.4와 R 3.5.2를 이용하여 수행했다. 연구결과 2007년 조사에서는 성별 흡연율이 유의한 차이를 보였고, 일반적으로 여성의 흡연율이 남성보다 더 많이 감소했다. 로지스틱 회귀 분석 결과, 남성, 고령자, 가정 실내 및 야외에서 간접흡연에 노출된 적 있는 경우, 담배 회사 로고가 박힌 물건을 소유한 경우 등이 현재 흡연과 유의한 연관성이 있는 것으로 나타났다. 2010년에 시행한 담배규제 정책은 현재 비흡연자인 경우에, 여성, 고령자, 가정 실내 및 야외에서 간접흡연에 노출된 경우, 언론의 흡연 장면에 노출된 경우, 담배 회사 로고가 박힌 물건을 소유하는 경우가 흡연 의도와 통계적으로 유의한 연관성이 있었다. 그러나, 담배 규제 정책을 시행한 2010년에는 비흡연자들이 미래에 담배를 피우고 싶어할 가능성이 높았다. 결론 GYTS는 담배 규제 정책을 입안하는 데 중요한 역할을 했고, 정책이 시행된 후에 흡연율이 일부 감소하는 양상을 보였다. 바베이도스는 청소년 흡연율을 더 감소시키며, 18세 미만 학생들의 흡연시작을 금지하고 간접흡연 위험을 감소시키기 위한 다양한 정책을 시행하기 위해 청소년 흡연율을 지속적으로 모니터링해야 한다.

Introduction Tobacco use is a major risk factor in chronic disease and thus adolescent smoking is of public health significance because many adult smokers will first initiate smoking as adolescents. About 20.2% of the world's population aged less than 15 years were current smokers in 2015, therefore smoking in young adolescents is an important public health issue. Barbados was one of the first countries to implement the Global Youth Tobacco Survey (GYTS) and has implemented four GYTS cycles so far. As a result of these surveys and subsequent tobacco legislation, Barbados has seen decreases in youth smoking prevalence.

Objectives The main objective of this research was to analyze the trends in tobacco use among adolescents in Barbados through four repeat national cross-sectional surveys (1999, 2002, 2007 & 2013). This research also explored the role the Global Youth Tobacco Survey played in implementing tobacco control legislature. Specific objectives included: determining which factors are significantly associated with the prevalence of youth cigarette smoking and investigating whether there is a gender difference in tobacco use in the 1999, 2002, 2007 and 2013 Barbados GYTS. Future intention to smoke was also analyzed to determine if current policies are effective at decreasing youth susceptibility to tobacco.

Methods Data from the Global Youth Tobacco Surveys (1999, 2002, 2007 and 2013) with a total sample of 4,786 students were analyzed. The dependent variables were current smoking status and intention to smoke. And the independent variables included: exposure to smoking in the home, exposure to smoking outside of the home, exposure to tobacco in TV, videos and movies, received tobacco education, ownership of an item with a tobacco product brand logo, exposure to anti-tobacco media messages, support for banning smoking in public places and implementation of the Health Services Regulations. Descriptive analysis and logistic analysis were carried out using SAS 9.4 and R version 3.5.2.

Results Current cigarette use decreased overall (by 35%) but female current cigarette use decreased significantly more than males over the four surveyed years. Adolescents who had ever tried smoking a cigarette decreased significantly overall by 29% and males were more likely to have ever smoked cigarettes than females. Adolescents who reported ever using other smoked tobacco products increased overall, but females alone saw a decrease. These results all showed a significant gender gap in 2007. Based on logistic regression analysis, being male, older, exposure to second-hand smoke in outdoor places, the home, and ownership of a tobacco brand logo were associated with current smoking status. The 2010 Health Services Regulations were significantly associated with low current smoking status. In non-current smokers, being female, older, exposed to second-hand smoke in the home, outside the home and the media and owning a tobacco brand logo was significantly associated with intention to smoke. However, in the period of the 2010 Health Services Regulations, non-current smokers were more likely to want to smoke in the future. Females in both categories had higher odds of being exposed to second-hand smoke in the home and owning tobacco branded items.

Conclusion The GYTS surveys played an important role in implementing tobacco legislature and some decreases in prevalence were seen after the laws were taken into effect. Nevertheless, Barbados must continuously monitor the prevalence of smoking among youth in order to further reduce tobacco use and to establish more positive policies such as placing more restrictions on tobacco advertising and promotion to prevent students under the age of 18 from starting smoking and to protect them from the risk of second-hand smoking.