Epidemiological Aspects of Nicotinism Among Students of Antananarivo Suburban High School (Madagascar)

Introduction: Nicotinism is of world-wide growing concern among adolescents. The goal is to describe the epidemiological aspects of nicotinism among Antananarivo suburban high school students. Methods: This is a descriptive and analytical cross-sectional study conducted in 2015 through a cluster sampling. A standardised, anonymous self-completion questionnaire was given to 903 high school students. Results: We enrolled 901 students. The prevalence of students who experimented with tobacco use was 46.3% next to 11.7% of active smokers . Among active smokers, 47.6% were non-dependent, 14.3% slightly dependent, 29.5% moderately dependent and 6.7% strongly dependent on tobacco. The motive of 70.3% of smokers was to test tobacco. Among former smokers 72.7% stoped smoking for fear of the drawbacks of tobacco-related diseases. Fear of heart disease (p = 0.004) and cancer (p = 0.008) was significantly associated with non-smoking status. Female gender (p = 0.000, OR 0.261 [0.164-0.415], 95% IC) and having been informed on tobacco consequences (p = 0.003, OR 0.401 [0.213-0.753, 95% IC] were protecting factors against tobacco use. The existence of a smoking circle was a risk factor of being a smoker: close friend (p = 0.000, OR 2,677 [2,027-3,534], 95% IC), cousin (p = 0.002, OR 1,529 [1,174-1,993], 95% IC), brother/sister (p = 0.023, OR 1,478 [1,054-2,072], 95% IC). Conclusion: The prevalence of nicotinism is significant despite the current prevention measures. The influence of the smoking circle and education are paramount. An active participation of nonsmokers adolescents in passing the message or raising awareness could improve the outcomes because they have influence on their peers.