The prevalence of current cigarette smoking among in-school adolescents in 2000 and 2006 were 15.2% and 16.7% respectively (p = 0.22) i.e. the change was not statistically significant. The male and females GYTS prevalence estimates of current cigarette smoking among in-school adolescent were: 7.6% and 6.4% in Barbados (2002); 6.2% and 3.7% in Bahamas (2004); 18.9% and 10.4% in Belize (2002); 14.1% and 13.8% in Haiti (2005); 11.5% and 7.9% in St Lucia (2000) and 16.0% and 7.6% in Trinidad and Tobago (2000) [12]. Furthermore the prevalence of current cigarette smoking in-school adolescents had been reported at 1%–4.5% in Ethiopia, [10], 3.0% in Blantyre-Malawi [13], and 17.5% overall prevalence in the Americas [14].
We also observed that the proportion of adolescents who reported having a parent who was a smoker reduced, so did adolescents who reported having been exposed to pro-tobacco advertisements through billboards and magazines. However the proportion of adolescents who reported owning an item with a tobacco brand logo increased. It is difficult to determine the reasons for increases in some of the characteristics while there are increased in other pro-tobacco measures.
One observation regarding the Jamaican tobacco landscape is that the country signed into the World Health Organization's Framework Convention on Tobacco Control (FCTC) on 24 September 2003 and adoption followed on 7 July 2005. Currently, Jamaica has banned tobacco advertisements on local television and radio programs but advertisements from international programs have not been banned. There are also tobacco cessation programs at some health facilities with nicotine replacement therapy available. However, more still needs to be done as advertisements in local newspapers, magazines, billboards, tobacco brand logos on items not related to tobacco, public environmental tobacco smoking have not been banned. There are however, national tobacco control objectives and a dedicated agency for the control of tobacco [12].
We also found that current smoking among the adolescents was associated with having closest friends who were smokers, parental smoking and male gender. Perception that smoking was harmful to health was associated with reduced likelihood of smoking.
Previous studies on adolescent smoking conducted elsewhere have also reported positive relationship between peer smoking, parental smoking, male gender and smoking [10]. Parental smoking may influence adolescent smoking by facilitating the ready availability of cigarettes in the home and moderating parental attitudes towards adolescent smoking. Peer smoking could influence adolescent attitudes and smoking in a similar way as has been described for parental smoking. It is also possible that adolescents who are smokers may be more likely to choose other smokers as closest friends. However due to the cross sectional nature of data collection over the two surveys, it is not possible to assign any of the factors as causes of adolescent smoking. Furthermore, for non-time varying factors such as sex, we cannot really say that male sex is the cause of smoking but rather that being male may be associated with other intermediate factors that may explain male predominance of smoking.
We found that adolescents who perceived that smoking was harmful were less likely to smoke and those who perceived that smoking made youth attractive were less likely to smoke. According to the PRECEED/PROCEED model of health promotion individuals are likely to adopt a healthy behavior if they have the appropriate knowledge and attitude, are exposed to reinforcing and enabling factors such as friends, family and health workers [15]. We therefore suggest that intervention programs should aim to change adolescent behavior by highlighting the harmful effects of smoking. There is need to ensure that adolescents are not exposed to images that glamorize smoking. Negative attitudes towards smoking may influence eventual avoidance of smoking among adolescents.
It is however interesting to note that exposure to pro-tobacco advertisement on television, magazines and newspapers and billboards declined from 2000 to 2006. However, ownership of item with tobacco brand logo increased over the period under review. Whether the decline in prevalence of exposure to advertisement was related to bans on local television programs remain to be seen. Paradoxically, the proportion of adolescents with favorable perception towards smoking increased.
In a study of high school forms 4 and 5 and Jamaica, Siyobo and Lee [16] reported prevalence of cigarette smoking at 16.6%. Males, urban residents and adolescents whose parents were skilled professionals were more likely to smoke than rural, female and children of less skilled parents. A comparison of the Soyibo and Lee report [16] and our findings from the current study (years 2000 and 2006 surveys), suggest stability of the prevalence of cigarette smoking among adolescents in Jamaica.