Abstract
Tobacco use is a significant concern in Asia. However, a paucity of research has assessed risk and promotive factors for youth tobacco use beyond demographics, or has systematically evaluated developmental differences in patterns of risk and promotive factors associated with tobacco use in this region. This study addressed this knowledge gap, with the goal of informing prevention approaches. Male public high school students (N = 842; M = 15.47, SD = 1.13 years) in Myanmar completed an adapted version of the Communities That Care (CTC) survey and questions on past month cigarette use. A series of path models and multiple group analyses were used to evaluate the associations of risk and promotive factors to current cigarette use, and age differences in these patterns. For both younger and older adolescents, associating with more drug-using peers increased the risk of tobacco use. For younger males, favorable attitudes toward antisocial behavior and poor family management were additional risk factors for tobacco use; for older males, parental attitudes favorable towards drug use and poor school achievement heightened students’ risk. Unexpectedly, parental attitudes favorable towards antisocial behavior was associated with a lower likelihood of older males’ smoking. Decreased risk of cigarette use was linked to opportunities for prosocial family involvement in younger males, and with rewards for prosocial community involvement in older males. These results suggest that interventions to reduce cigarette use in Myanmar should target different levels of male adolescents’ social ecologies, and attend to developmental differences in patterns of risk and protection.
Highlights
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Identified age differences in male Myanmar adolescents’ risk for recent tobacco use.
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Risk and protective factors for tobacco use varied across life domain and age group.
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Peer drug use was the only common risk factor across age groups in the study.
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Prosocial family involvement was protective against tobacco use for younger males.
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Prosocial community involvement was protective against tobacco use for older males.
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Acknowledgements
We acknowledge the support of the Humbert H. Humphrey Fellowship Program. This program brought the third author to the first author’s University, and provided support for his training during which time this study was designed. We also thank John Skaritza, Director of Information Technology (IT) in the College of Humanities and Sciences, and Logan Bishop, an IT expert in the College at the first author’s university, who provided technical assistance for the study; Brittani Parham, Patrick Silva, and David Sosnowski, who oversaw data transfer, management, and cleaning in the first author’s research lab; and the following research assistants who supported these efforts: Robert Laverdy, Richard Mensah, Carolyn Booth, Price Withers, and Sawyer Wilkins. Without their support, completion of this study would not have been possible. Brittani Parham is now at the University of Michigan; David Sosnowski is now at the Johns Hopkins University.
Author Contributions
W.K. co-conceived of the study, performed statistical analyses and interpreted the findings, and drafted the article; R.L. conducted literature reviews, conducted some statistical analyses, and drafted portions of the article; N.M. Wan co-conceived of the study, collected the data, provided cultural interpretation for some of the findings, and reviewed drafts of the manuscript. All authors read and approved the final manuscript.
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The authors declare no competing interests.
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All procedures performed in this study that involved interaction with human participants were in accordance with the ethical standards of the first author’s University (approval #HM20004686 granted May 27, 2015) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Parents or legal guardians provided written informed consent to allow their children to participate in the study.
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Kliewer, W., Lecaj, R. & Wan, N.M. Cigarette Smoking in Male High School Students in Myanmar: Developmental Differences in Risk and Promotive Factors. J Child Fam Stud 32, 1192–1203 (2023). https://doi.org/10.1007/s10826-022-02340-y
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DOI: https://doi.org/10.1007/s10826-022-02340-y