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BACKGROUND
In August of 2004, Trinidad & Tobago ratified the Framework
Convention on Tobacco
Control. The framework Convention calls for smoke-free
environment in indoor public
places, indoor workplaces, public transport and other public
places as deemed
appropriate.
In support of this move, The Pan American Health Organization
(PAHO) embarked upon
a smoke-free pilot Project in conjunction with The North West
Regional Health
Authority, the University of the West Indies, the National
Parent -Teachers Association
and the Power Generation Company of Trinidad Tobago . The
project aims, firstly, to
raise the awareness of the harm caused by second-hand smoke and
secondly, to
emphasise the need to promote written and enforced policy
requiring key sectors to
become smoke-free.
In this regard, The Coalition for a Tobacco-Free Trinidad &
Tobago as the leader of the
campaign sought the cooperation of the University of the West
Indies (UWI) to fulfill one
of the activities of the project, which is to conduct and
publicize the results of public
opinion polls on a smoke free environment at the University of
the West Indies.
The Health Service Unit of the St. Augustine Campus led the
initiative to collaborate
with The Coalition for a Tobacco-Free Trinidad & Tobago to
conduct a survey on the
UWI campus. The objectives of the survey were outlined as
follows;
To obtain evidence on the prevalence of smoking of a sample of
the student
population on the St. Augustine Campus
To obtain an understanding of the attitudes, knowledge and
behaviors related to
smoking and its health impact
To assess the opinion of students towards a smoke free campus
environment
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To provide information to guide in policy / programming planning
in addressing
tobacco use on the campus
INTRODUCTION
CURRENT SITUATION
NATIONAL
An estimate of tobacco use among the youth in Trinidad &
Tobago is difficult to
determine in light of the limited number of studies previously
conducted. The Global
Youth Tobacco Survey conducted in 2000 found among their
conclusions that about 40%
of all students between the ages 13-15 have experimented with
cigarette smoking at one
or another; that an equal percentage of male and females are
experimenting with smoking
before the age of 10; that media advertising is a major
contributor; and that a major
influential factor is that they live in households where parents
and other adults smoke.
Additionally, the majority felt that in order to curb exposure
to environmental tobacco
smoke, smoking should be banned in public places.
INTERNATIONAL
In a 1999 national survey (N. Rigotti, JE Lee and H Wechsler
Jama 2000;699-705) of
119 national four- year colleges in the United States , the
primary objectives were to
assess the prevalence of all forms of tobacco use among US
college students and to
identify student and college level factors associated with use.
It was intended that the
study would provide the opportunity to explore the impact of
Massachusetts Tobacco
Control Program on smoking by young adults. It was found that
students in those
colleges use tobacco products at substantial rates and the
cigarette smoking was said to be
just under 30%.
The study concluded that tobacco use was common among college
students and that
colleges appeared to be the time when many students were
experimenting with tobacco
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products and were susceptible to developing nicotine dependence
and that Colleges
provided the opportunity for intervention to discourage tobacco
use.
THE SURVEY
METHODOLOGY
Sampling
The sample size was initially based on 10% of the current
(2004/2005) student population
at the St. Augustine Campus, UWI. Faculty samples were
calculated based on its
proportionate ratio to total existing enrolment. On that basis,
the sample population to be
targeted for each faculty was then divided equally into years 1,
2 and 3 at the
undergraduate level. The calculation resulted in a sample size
1200 students of which 200
were postgraduates.
Data on class sizes for all faculties were obtained from The
Campus IT department and
this information was used for the distribution of the
questionnaires. Both undergraduate
and postgraduate classes to be surveyed were then randomly
selected based on the faculty
ratios.
Questionnaire
The Global Tobacco Youth Survey was chosen as the most
appropriate questionnaire.
This questionnaire is available to all countries and was
developed by The World Health
Organisation (WHO) in conjunction with the Tobacco Free
Initiative (TFI), the United
Nations Childrens Fund (UNICEF), and the Office on Smoking and
Health Centers for
Disease Control and Prevention (OSH-CDC). The questionnaire is a
standard instrument
used to assess smoking prevalence and other variables related to
smoking in the youth
aged 13-15.
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The questionnaire originally had fifty-six questions, but
modifications were made to
make them more culturally relevant and more appropriate to the
age of the students
population at the St. Augustine Campus. The revised
questionnaire for the Smoking
Survey at the St. Augustine Campus comprised forty-four
questions, the first eight of
which related to personal information on gender, age, ethnicity
and status at UWI. The
remaining questions dealt with experience, knowledge and
opinions towards smoking,
exposure to smoking, and attitudes toward stopping smoking and a
smoke free
environment on the campus.
The questionnaires were distributed to classes by field officers
and self administered by
respondents. Questions had response categories, which had to be
ticked off. Multiple
responses to any question were not allowed and participation was
voluntary and
anonymous.
Data Collection
The distribution of the questionnaires was handled by students
who were hired
specifically to administer the questionnaires, give a brief
introduction to the survey,
collect and collate them and return them to the project
coordinator.
Analysis
The Database manager and an assistant entered data into the
Access database for the
creation of queries and reports. The Project Coordinator
analysed the data, which formed
the basis of the observations and trends that were highlighted.
The limitations of the
analysis were also discussed and proposed action for follow up
was identified.
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RESULTS
A total of 1165 students of the 1200 students targeted on the
St. Augustine Campus, UWI
undertook to participate in the survey. This yielded a 97%
response rate. The sample
included students across the five faculties, and from all three
levels of study. All 1165
respondents did not however, answer all the questions. For the
purpose of this paper the
sample population decided upon was based on 1144 respondents.
These respondents
however, all answered the question, which was used to determine
current smokers from
non-smokers.
Characteristics of the sample
Of the 1144 respondents, 90% were undergraduates and 10% were
postgraduates. The
distribution of the respondents by faculty was as follows;
Education 4.47%, Engineering
16%, Humanities 17.0%, Law 2.2%, Medical Sciences 7.6%, and the
majority from
Science and Agriculture 30% and Social Sciences 25%.
In terms of gender distribution, approximately 40 % were male
and 60% female, 52% of
the sample was between the ages 18-21, 27% between 22-25 and 20%
over 25. In terms
of ethnic background, 39 % was of Indian origin, 35% African,
22% of mixed races and
4% of Chinese, Spanish, Syrian and other ethnicities.
Eighty-nine percent of the sample population was single and 10%
percent married. The
majority of the students (85%) were registered as full-time and
38% were in level 1 (or
first year), 32% in level 2, 25% in level 3. Less than 3% were
in levels 4 and 5 and this
comprised mainly students in the faculty of Medical
Sciences.
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Experimentation with smoking
Students were asked whether they had ever tried or experimented
with cigarette smoking,
even one or two puffs, the results indicated that 567 or 49% of
the respondents answered
positively, of which 53% were female and 43% male. From the base
of the sample
population, the majority of students who admitted to having
experimented with smoking
came from Science and Agriculture (26%) and Social Sciences
(26%), Engineering
(16%) and Humanities (16%) and 45% were in the age group
18-21.
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Chart 1 Experimentation with Smoking
0
10
20
30
40
50
60
Per
cent
age
Female
Male
Female 26.4 33.3
Male 23.1 16.8
Yes N o
Chart 2 -Experimentation with Smoking
0
1
2
3
4
5
6
7
8
9
Education Engineering Humanities Law MedicalSciences
Sciences SocialSciences
Per
cen
tag
e
Female
Male
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Prevalence of smoking
In order to assess the prevalence of smoking on the campus, the
methodology defined
current smokers, as students who had smoked cigarettes on one or
more occasion within
the last thirty days. 122 students or 11% of the respondents
were identified as current
smokers. More males (64%) were current smokers than females
(36%). Thirty-seven
percent of respondents indicated that they were 16 years or
older when they first tried a
cigarette, inferring that most students first tried smoking
under 16 ( 26% of whom were
between 14-15).
Current smokers
The highest percentage of current smokers were in the faculty of
Science and Agriculture
with 27%, Engineering with 24% followed by Social Sciences 21%,
Humanities 13%,
Medical Sciences 8%, Education 2.5% and Law 1.6%. More students
from the younger
age group18-21 were current smokers (56%), about 28% were
between the ages 22-25
and 11 % over 25.
Smokers were also assessed in terms of their ethnic background.
According to the data
response persons of Indian background smoked most (51%), others
were of mixed races
( 26%), and Africans at 19%. Smokers of Chinese, Spanish, Syrian
and other ethnicities
comprised 2.4%.
Many of the current smokers (27%) said that they most smoked at
social events, less at
home (22%) and the least at school (17%). The majority of
students who were smokers
(83%) mainly chose cigarettes as their only form of tobacco
use.
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Table 1 : Experimentation and Prevalence
Category Experimentation
Prevalence Current smokers
First Smoked Cigarette before age of 16
Total 49.5 10.7 13.0
Male 46.5 63.9 14.6 Gender Female 53.2 36.0 13.1
Engineering 16.2 23.8 6.3
Education 5.3 2.5 0.7
Humanities 15.9 13.1 4.2
Law 1.4 1.6 0.3
Medical Sciences
8.1 8.2 2.5
Science & Agriculture
25.6 27.0 7.0
Faculty
Social Sciences
25.6 20.5 7.2
25 23.8 11.5 5.6
Age
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Chart 3 -Current smokers by Gender & Faculty
0
10
20
30
40
50
Per
cen
tag
e
Male
Female
Male 0.0 23.0 7.4 0.0 4.9 16.4 9.8
Female 2.5 0.8 5.7 1.6 3.3 10.7 10.7
Education Engineering Humanities Law Medical Sciences Sciences
Social Sciences
Chart 4-Current Smokers by Gender& Ethnicity
0
10
20
30
40
50
60
Per
cen
tag
e
Male
Female
Male 0.8 31.1 17.2 13.1 0.8 0.0
Female 0.0 19.7 9.0 5.7 0.0 0.8
Chinese Indian Mixed African Spanish Syrian
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Chart 5 - Current Smokers by Gender & Age
0
10
20
30
40
50
60
70P
erce
nta
ge
Male
Female
Male 0.8 36.9 20.5 4.9
Female 0 21.3 7.4 7.4
>18 18-21 22-25 >25
Chart 6 - Current Smokers by Gender & Level of Study
0
5
10
15
20
25
30
35
40
45
50
Per
cen
tag
e
Male
Female
Male 15.6 23.8 18.9 2.5 0.8
Female 13.1 13.9 8.2 0.0 0.8
Year 1 Year 2 Year 3 Year 4 Year 5
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Frequent Smokers
Students who smoked cigarettes on 20-30 days of the month were
considered frequent
smokers. Approximately, 40% of the current smokers were frequent
smokers with the
highest percentage of frequent smokers being in Engineering and
Science and Agriculture
at 28% each. There were more male frequent smokers (73%) as
compared to female ones
(27%). Some 28% claimed to be casual smokers or those smoking
only on one or 2 days
of the month. At least 51% of the smokers indicated that they
smoked anywhere from 2
to 10 cigarettes a day.
Age of first attempt with smoking
When asked how old they were when they first tried a cigarette,
54% stated that they
were between 10-15, 37% indicated that they were 16 or older and
only 8% of the current
smokers said they were younger than 10.
Knowledge and Attitudes Towards Smoking
The question was posed to current smokers as to whether anyone
in the family had
discussed the harmful effects of smoking with them. It was
concluded that more smokers
(63% of which 69% were male) than non-smokers (47% of which 66%
were female)
indicated that they did have discussions.
In response to question as to whether they thought smoking
cigarettes helped people feel
more or less comfortable at celebrations, parties, or in other
social gatherings, both
current smokers and non- smokers equally believed that it made
people feel more
comfortable.
In general, the majority of respondents believed that smoking
was harmful to ones
health. Among the current smokers, 73% (of which 60% male)
indicated that it was
definitely harmful, and as predicted, many more of the
non-smokers (93% of which 64%
were female) shared the same opinion.
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When asked about their impressions of a man smoking, the
majority of the results
indicated that the respondents had negative impressions.
Seventy-five percent of the non-
smokers indicated that they thought the man was stupid, lacking
confidence and felt they
were losers. However less of the smokers (22%) shared the same
view.
In reference to a woman smoking, more non-smokers (83%) than
smokers (34%) felt
women lacked confidence, were losers or were stupid.
Chart 7 Attitudes towards Smoking
0102030405060708090
100
Think smoking is harmful toone's health
Think smoking makes peoplefeel comfortable
Think smoke from other people'scigarettes is harmful
Per
cen
tag
e
Current smokers
Non-smokers
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Table 2 : Knowledge and Attitude
Think smoking makes people feel more comfortable
Think smoking is definitely harmful to ones health
Has negative impressions of man who smokes
Has negative impressions of a woman who smokes
Category
Current smokers
Non-smokers
Current smokers
Non-smokers
Current smokers
Non-smokers
Current smokers
Non-smokers
Total 40.9 42.0 73% 92.5 35.2 74.6 22.1 82.6
Male 30.3 14.5 45.9 32.7 15.5 26.0 25.4 29.3 Gender
Female 10.6 27.2 27.0 59.5 6.5 48.4 9.8 53.0
Engineering 11.5 7.0 15.6 13.6 4.1 10.8 9.8 12.2
Education 0.8 0.0 2.5 4.2 0.8 3.3 0.8 3.5
Humanities 4.1 7.0 9.8 15.8 2.5 13.5 4.9 14.9
Law 0.8 1.1 0.8 2.3 0.0 2.0 0.0 2.1
Medical Sciences
4.9 4.0 4.9 7.2 1.6 6.0 3.3 6.3
Science & Agriculture
9.0 10.6 18.9 25.3 4.9 20.0 8.2 22.9
Faculty
Social Sciences
7.4 9.8 18.0 23.0 6.6 18.5 6.6 19.9
25 3.3 7.5 6.6 18.8 1.6 15.3 1.6 16.6
Age
Social Influence
It was found that 23% of the students who were surveyed had
parents who smoke. More
current smokers (38%) indicated that either one or both of their
parents smoke, but of the
non-smokers less of them (22%) said that their parents
smoke.
In reference to the question about having close friends who
smoke, it was found that the
majority (97%) of the current smoker respondents replied
positively, 64% of which were
males. Contrastingly, less of the close friends (53%) of the
non-smokers were smokers.
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Chart 7 -Social Influence
0102030405060708090
100
Have parents who smoke Have close friends whosmoke
Harmful effects of smokinghas been discussed in the
family
Per
cent
age
Current smokers
Non-smokers
Exposure to Smoking
The belief that smoke from other peoples cigarettes was harmful
was felt by 84% of the
sample population on the whole but more non-smokers (87%)
compared to current
smokers (62%) agreed with this view.
Students were also asked to respond to whether or not they were
in favour of banning
smoking in public places (restaurants, buses, schools,
playgrounds, gyms, sports arenas
discos etc.) The general response from the sample population
suggested that 85% (63%
female, 31% male) were agreeable to banning smoking in public
places. Only 41% of the
current smokers said yes to banning smoking in public areas.
Among the non-smokers
ninety percent of the respondents were more inclined to banning
smoking in public places
and more females (64%) than males (35%) supported the
choice.
Student opinion on banning smoking in designated student areas
on the campus was also
assessed. The data indicate that overall, a majority of 88% of
the sample population (62%
female and 38% male) preferred smoking to be banned on the
campus. At a closer
analysis, a greater proportion (93%) of the non-smokers favored
a smoke free campus
while only 52% of the current smokers supported that option.
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Chart 9- Exposure to Smoking
0102030405060708090
100
Exposed to smoke athome
Exposed to smokefrom other places
than home
In favour of banningsmoking in public
places
In favour of banningsmoking on the
campus
Per
cen
tag
e
Current smokers
Non-smokers
Table 3 : Exposure to Smoking
Exposed to smoke from others at home
Definitely think smoke from others is harmful to them
Percentage who think smoking should be banned in public
places
Percentage who think smoking should be banned in student areas
on Campus
Category
Current smokers
Non-smokers
Current smokers
Non-smokers
Current smokers
Non-smokers
Current smokers
Non-smokers
Total 59.8 30.0 63.0 87.0 40.9 90.1 52.4 93.0
Male 43.4 11.9 39.3 30.4 16.4 32.2 30.3 33.5 Gender
Female 16.4 18.0 23.0 56.4 24.5 57.7 22.1 59.2
Engineering 14.8 4.8 14.8 12.9 9.8 15.1 9.8 15.2
Education 2.5 1.2 1.6 4.0 1.6 4.5 1.6 4.6
Humanities 7.4 5.3 9.0 15.3 4.9 17.1 6.6 17.1
Law 0.8 0.4 0.8 2.0 0.8 2.2 0.8 2.3
Medical Sciences
6.6 2.8 2.5 6.5 1.6 7.5 1.6 7.5
Science & Agriculture
19.7 8.9 17.2 24.0 8.2 27.1 17.2 27.1
Faculty
Social Sciences
6.6 6.3 13.9 21.3 12.3 25.0 12.3 25.0
25 7.4 5.1 4.1 18.3 2.5 19.7 4.1 19.9
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Intention to smoke / Desire to stop.
The non-smokers indicated that only 3% of them would definitely
smoke if one of their
best friends offered them a cigarette, the majority of whom were
females (71%).
However, less than 2% of them thought that they would be smoking
cigarettes 5 years
from now.
Just about 34% of the current smokers indicated that they wanted
to stop smoking but
more males (74%) than females showed this desire. Thirty-six
percent of those who
indicated a desire to stop smoking was from the faculty of
Science and Agriculture but
of the 39% who said that they did not want to stop smoking, at
least 31% was students
from Engineering.
Of the smokers who responded, 46% indicated that they had
stopped smoking (61%
males 39% females) and 41% stated that they had stopped anywhere
between 1 to 11
months.
Only 16% of the current smokers ever received help to stop
smoking, and 36% of those
who said they had stopped indicated that improving their health
was the main reason for
doing so.
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DISCUSSION
Observations
At least 50% of all the respondents had experimented with
smoking at one time, but more
females (53.2%) than males (46.5%) had tried smoking. It is also
evident that more
persons in the younger age group 18-22 had tried their first
cigarette before the age of 16.
The habit of smoking was more prevalent among the male gender as
64% of the current
smokers were male and 36% female. Students in the age group
18-21 comprised most
(58%) of the current smokers.
Frequent smokers were defined as those who smoked on all of the
30 days. The
percentage of frequent smokers among the current smokers was
found to be significantly
high at 33% (75% percent of whom are male).
Students were divided on the issue of whether smoking made
people feel comfortable,
42% believed it made people feel more comfortable, 42% said
there was no difference
and 11% indicated that it made people feel less comfortable.
Persons who had close
friends who smoked also tended to be smokers as distinct from
non-smokers who had less
close friends who smoked. At least 65% of the respondents were
not exposed to other
peoples smoke in their homes but 73% claimed that they were
exposed to other peoples
smoke in places other than their home anywhere from 1 to 7 days.
In the male dominated
faculty of Engineering smoking tended to be more acceptable and
there was more
reluctance from them to stop smoking.
An overwhelming 90% of the sample population agrees that smoking
is definitely
harmful to ones health, while 84% think that smoke from other
peoples cigarettes is
harmful to them. The consensus (85% of the sample population) on
the campus is that
smoking should be banned in public places and more believe (88%)
that this should be
extended to student areas on the campus. It must also be
recognised that a significant
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proportion of the student sample have articulated a desire to
stop smoking but
interestingly less females have indicated this will.
Limitations
The analysis of the survey was restricted to the extent where
students failed to complete
responses to some questions. Although the questionnaire included
a wide range of
questions regarding the use, attitude, beliefs, influence and
exposure to smoking, the
analysis was limited to a selected number of questions, focusing
on the prevalence and
experience in smoking behavior and attitudes of the student
population towards a smoke
free campus. Responses were few in number at the postgraduate
level and not evenly
distributed and they were therefore considered to be too few to
lend significance to the
study.
Some answers were ambiguous and this created a difficulty in the
analysis particularly as
it was related to the response, I have never smoked cigarettes
which was identified as a
response in more than one question. In all instances the numbers
responding were
different.
This survey is the first of its kind to be conducted on the
campus and therefore
comparisons could not be drawn to measure any change in the
pattern of smoking nor the
profile of smokers. The existing national survey entitled,
Global Youth Tobacco
Survey conducted in 2000 by the Ministry of Health dealt mainly
with the target age
group 13-15 in 61 schools across the country. While the report
concentrated on a
younger survey population, it was able to conclude that
cigarette smoking was a cause for
growing concern and that among those surveyed at least 40% has
smoked cigarettes once
in their lives.
Comparative Data
In the final report of the task force on a smoking survey (June
2004) conducted at the
three campuses of the University of New Brunswick, Canada, it
was noted that
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approximately 16% of the 1144 student respondents smoked. The
trends have been
similar to the study at UWI in that, about 40% have thoughts of
quitting while 98% were
aware of the health issues related to smoking and 92% were
concerned about the effects
on their health.
Across the three campuses there were general encouragement for
added measures to
reduce smoking on the campus ranging from 75% to 85% and 60% to
70% backing for
the total ban on smoking on the campuses.
At the California State University Sacramento, California, US,
results of a 2003 survey of
1155 respondents demonstrated that there was a decline in the
percentage of students who
were smokers from 32% in 2001 to 15% in 2003. The issue of
secondhand smoke was a
main concern to 60% of the survey respondents while 52%
indicated that it was important
to have campus designated smoking areas.
Conclusions
It has been observed that while only 11% of the students have
admitted to being current
smokers the practice of smoking is more common among the younger
age group 18-21,
which represented 56% of the smokers, and at least 43% of this
age cohort indicated that
they first smoked a cigarette under the age of 16.
There was a higher ratio of smoking among the male population
and those in the
faculties of Science and Agriculture and Engineering and also
among students registered
in level two and from Indian ethnicity. There was less
occurrence of smoking among
persons of African and Mixed descent. There was also a higher
incidence of smokers
among those who had parents and or close friends who smoked.
Exposure to environmental smoke is a growing concern among the
student population.
Opinion on the harmful effects of smoking to ones health and
from other peoples smoke
and tend to be stronger among the non-smokers and there is also
overwhelming support
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for banning smoking in public places and select student areas
and the campus. Notably,
there is also considerable support from the smoking population
for the creation of a
smoke free campus.
The information from the smoking students indicates that there
is a receptiveness towards
quitting smoking and similarly and a greater inclination from
them to having tried stop
smoking cigarettes in the past year. A significant proportion
(38%) have claimed that
they have never received help nor advice to help them stop
smoking, it seems therefore
that this is an opportunity for the campus to foster programmes
to assist those who are
partial to giving up the habit.
It is safe also to assume from the available data that less than
20% of the persons
identified as nonsmokers, would ever begin to smoke.
Follow-Up
As part of the objective of this survey, it is important to
acknowledge the indicators of
the sample population as representative of the campus body.
Smoking is evidently
unpopular and the general feeling is that environmental smoke is
unwanted. There is also
strong advocacy for mechanisms to be put in place for
establishing smoke free student
areas on the campus in support of the general consensus.
The survey has been able to identify where and with whom, the
prevalence of smoking is
greatest. There must therefore be more surveillance in terms of
programmes and policies
to be developed for smoking cessation and for the intervention
required to discourage
smoking and other forms of substance abuse especially where the
use patterns are related
One item for follow up is the commitment to repeat similar
surveys in the future for the
continuous monitoring of the habitual trends of the student
population in tobacco and
other forms of substance use.
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References
1. The Ministry of Health, Directorate of Health Policy ,
Research and Epidemiology, B.
Carr, L. Alleyen and D. Renaud Global Youth Tobacco Survey. June
2000.
2. N A Rigotti, S Regan, N E Majchrzak, J R Knight and H
Wechsler, Tobacco Use by
Massachusetts Public College Students: long term effect of the
Massachusetts Tobacco
Control program. Tobacco Control 2002;11(Suppl 11) ii 20-
ii24
3. P. Bovet, B Vishwanathan, W. Warren, Ministry of Health ,
Victoria , Seychelles, The
Global Youth Tobacco Survey in the Seychelles 2002.
4. International Union against Cancer (UICC) & Tobacco
Control Resource Centre, J.P
Pierce, Conducting a smoking prevalence survey. (http://
factsheets.globallink.org/en/prevalence.
5. Statistics Canada: 2002 Youth Smoking Survey.
6. D. Wybou , A Final Report of a Task Force on Smoking Survey,
The University of
New Brunswick, June 2004. Submitted to the UNB Joint Health and
Safety Committee.
7. Survey of the California State University 2003.
www.sacstand.org/survey