Objectives To examine the associations of current tobacco use with tobacco advertising, promotion and sponsorship (TAPS), and illicit tobacco sales exposures among Myanmar high school students.
Design A quantitative, cross-sectional study.
Setting Seven high schools from both urban and rural areas of four states and regions in Myanmar.
Participants In total, 1174 high school students (482 males and 692 females) were interviewed using a self-administered questionnaire.
Main outcome measure Current tobacco use of participants, defined as using any kind of smoked or smokeless tobacco product at least one occasion within the past 30 days.
Results The prevalence of TAPS exposure was 90.9% among high school students in Myanmar. Current tobacco use was positively associated with being over 14 years old (adjusted OR (AOR) 9.81; 95% CI 4.54 to 21.19), being male (AOR 28.06; 95% CI 13.29 to 59.25), exposure to any kind of TAPS (AOR 6.59; 95% CI 2.33 to 18.64), having seen any smoked tobacco product for sale inside or within 100 feet of the school premises (AOR 4.17; 95% CI 1.65 to 10.58), having seen the sale or gifting of any smoked tobacco product to minors (AOR 6.46; 95% CI 2.18 to 19.12) and having seen the sale or distribution of any smoked tobacco product by minors (AOR 2.42; 95% CI 1.42 to 4.10). Having ever received health education about tobacco use (AOR 0.45; 95% CI 0.27 to 0.78), or having a higher perception score of tobacco use (AOR 0.17; 95% CI 0.10 to 0.30) were negatively associated with current tobacco use.
Conclusions There was an alarming prevalence of TAPS exposure among Myanmar high school students. TAPS exposure and violations of tobacco sale regulations were strong risk factors for current tobacco use among Myanmar high school students, while health education about tobacco products was reported as an effective protective factor. Specific smokeless tobacco sale regulations for minors are needed immediately in Myanmar.
- tobacco advertising
- tobacco sale
- high school students
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
Contributors YMS and NNL conceptualised the study and designed the study. NNL and TNS contributed to data collection and data acquisition. YMS, TNS, HH and SMC performed data analyses and data interpretations. YMS, HH and SMC wrote the first draft of the manuscript. MK, TMT, EMW, TK, EY and ZZA contributed to data acquisition. NH contributed to the study design, data interpretation and revising the manuscript. YMS, TNS, SMC, and NH revised and edited the manuscript. All authors had full access to the data, and take responsibility to the accuracy of data analysis. All authors approved the final manuscript and agreed to submit it for publication and take accountability.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval This study was ethically approved by the Department of Medical Services, Ministry of Health and Sports, Myanmar (Letter No. 617 of Planning/Research issued on 26 August 2015), and the Ministry of Education, Myanmar (Letter No. 12125 of Information/Research issued on 19 October 2015), as well as the ethical review committee of Nagoya University School of Medicine (No. 6518 issued on 31 August 2015). To conduct this school-based survey, permissions from Ministry of Education, Regional Offices of Basic Education, Ministry of Health and Sports, local educational steering committees and authorities, the schools’ authorities, the headmasters of participated schools and local Parents-Teacher Associations were obtained. The survey procedure was approved by Ministry of Education and Ministry of Health and Sports. After thoroughly explaining the study’s objectives, contents of the survey questionnaire and rights of the study participants, the written-informed consents from local educational steering committees and authorities, the schools’ authorities, the headmasters of participated schools, local Parents-Teacher Associations and parents were obtained. One week prior to the survey, the information sheet and the written-informed consents stating the study’s objectives, the survey’s procedure and the contents of the questionnaires and the rights of the study participants were sent to parents. Researchers also explained the study’s objectives, contents of the survey questionnaire, the voluntary nature and procedure of the survey and the rights of the participants to collaborators, students and teachers before conducting the survey. All data collection and analytical processes remain anonymous for privacy and confidentiality. The locations, names and numbers of the eligible participants of the schools involved were not documented.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No additional data are available.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.