Tobacco Use Among 13–15 Year Olds in Sri Lanka, 1999–2007

May 23, 2008 / Vol. 57 / No. 20

MMWR Highlights

Cigarette Smoking

• Lifetime cigarette use among students in Sri Lanka significantly declined between 1999 (12.1%) and 2003 (6.3%); the decrease continued to 2007 (5.1%), but not significantly.
• Boys were significantly more likely than girls to have ever smoked cigarettes in 1999 and 2003, but there was no significant difference in 2007.
• For boys, current cigarette smoking decreased significantly between 1999 (6.2%) and 2007 (1.6%), while for girls the rate remained unchanged.
• Boys were significantly more likely than girls to be current smokers in 1999, but in 2003 and 2007, there was no gender difference.
• The percent of students who reported that their parents smoke significantly decreased between 1999 (50.8%) and 2007 (29.9%).

Other Tobacco Products

• Current use of other tobacco products remained unchanged between 1999 and 2007, both overall and within gender.
• Boys were significantly more likely than girls to use other tobacco products in 1999; but there was no gender difference in 2003 and 2007.
• Current use of other tobacco products was significantly higher than cigarette smoking overall in 1999, 2003, and 2007.
  • For boys in 2003 and 2007.
  • For girls in 1999 and 2003.

Tobacco Advertising & Promotion

• Both direct and indirect advertising and promotion decreased significantly between 1999 and 2007.
  • The percentage of students who saw pro-tobacco advertisements on billboards did not change significantly between 1999 and 2003, but significantly decreased between 2003 and 2007 (79.3% in 2003 to 67.4% in 2007).
  • The percentage of students who saw pro-tobacco advertisements in newspapers and magazines significantly declined between 1999 and 2007 (83.4% in 1999; 78.4% in 2003; 68.4% in 2007).
  • The percentage of students who owned an item with a tobacco logo on it did not change between 1999 and 2003, but significantly decreased between 2003 and 2007.
  • The percentage of students who reported receiving free cigarettes from a tobacco company representative decreased significantly from 1999 (6.4%) to 2007 (3.0%).

Other Highlights

• Exposure to secondhand smoke in public places remained unchanged over time (67.9% in 1999 and 65.9% in 2007).
  • Sri Lanka's ban on secondhand smoke exposure does not include exposure in restaurants, pubs or bars, and these exclusions may explain the lack of change in exposure.
  • A number of studies have shown that secondhand smoke laws are most effective when a complete ban on smoking in indoor workplaces is enacted and strongly enforced.
  • The 2006 report of the U.S. Surgeon General states "that only comprehensive smoke-free workplace laws can protect all workers and the public from the dangers of secondhand smoke."
• Support for a ban on smoking in public places did not change significantly between 1999 (91.4%) and 2007 (87.9%).
• In 2007, 76.5% of current smokers indicated they would like to stop smoking and the rate did not change significantly between 1999 and 2007.
• The percent of students who reported having been taught in school during the past school year about the harmful effects of tobacco significantly increased between 1999 (62.7%) and 2003 (79.8%) but remained unchanged between 2003 and 2007 (72.8%).

Background

• A recent World Health Organization (WHO) report shows that the government of Sri Lanka has taken strong measures in tobacco control.
  • Sri Lanka ratified the WHO Framework Convention on Tobacco Control in 2003.
  • Exposure to secondhand smoke is banned in health care, education, and government facilities, as well as in universities, indoor offices, and other indoor workplaces.
  • Laws have been enacted to prohibit pro-tobacco advertisements on national television and radio, in local magazines and newspapers, on billboards, at points of sale, and on the Internet.
    • This includes a ban on tobacco promotional items, such as free distribution, promotional discounts, and sponsored events.
  • The bans on exposure to secondhand smoke, advertising, and promotion are part of the National Authority on Tobacco and Alcohol Act (NATAA) enacted by Sri Lanka in 2006.
  • NATAA's ban does not include international television and radio or international newspapers and magazines.
• Tobacco use is one of the major preventable causes of premature death and disease in the world.
  • WHO attributes more than 5 million deaths a year to tobacco use, and this total is expected to exceed 8 million a year by 2030.
  • A disproportionate share of the global tobacco burden falls on developing countries where 84% of the 1.3 billion current smokers live.
• The Global Youth Tobacco Survey, part of the Global Tobacco Surveillance System initiated by WHO, CDC, and the Canadian Public Health Association is a school-based survey developed to monitor youth tobacco use, attitudes, and exposure to tobacco smoke and has been completed by more than 2 million students in 151 countries.