Gender specific factors associated with having stopped smoking among in-school adolescents in Ukraine: results from the Global Youth Tobacco Survey 2005

The prevalence of tobacco smoking in Ukraine is among the highest in the world [1, 2]. Furthermore, the age of initiation is getting lower [3]. In the Kiev Global Youth Tobacco survey conducted in 1999, 41% of 13 to 15 year old in-school reported being current cigarette smokers [4, 5].

The Health Belief Model (HBM) is a psychological model that aims to explain and predict health-related behaviours. The model focuses on the attitudes and beliefs of individuals [6, 7]. One other aspect of the HBM is the role of cues of action such as a lesson in school or a family member who discusses the harmful effects of smoking with the adolescent. The HBM has been partly used in predicting health behaviour, including smoking, among college students [8]. We used this model to identify factors that we used in the analysis.

While the incidence and prevalence of smoking in Ukraine has been reported to be growing [2], there are limited data on the cessation of smoking among adolescents and more so on gender-specific correlates for stopping smoking. In order to inform smoking prevention programs in Ukraine, we explored the gender-specific correlates of self reported cessation of smoking among adolescents.

Our analysis of the Ukraine Global Youth Tobacco Survey 2005 has shown that, unlike among adults [1], there was no gender difference in cigarette smoking. This finding is consistent with previous reports which have indicated that there is no gender difference in tobacco use in Europe and United States [10, 11]. Using data from repeat GYTS from 100 sites around the world, Warren et al report that tobacco use among girls is likely increasing [12]. We first present a discussion of factors associated with stopping smoking that were not significantly different between gender, and then present factors associated with stopping smoking that were different between gender.

Both male and female adolescents who were younger were less likely to stop smoking suggesting that this was the age group for experimenting smoking, and those not in favour of the behaviour would have more likely stop smoking immediately. Meanwhile, adolescents who would have continued to smoke would have been less likely to stop smoking at a later age.

There were no gender differences in smoking cessation related to age, being offered a cigarette by a best friend, weight increase, and getting support or advice on how to stop smoking from a professional or friend. Both male and female adolescents who were of age less than 13 or of age 14 years, certain that cigarette smoking is harmful to health, and had received help on quitting smoking from a professional or friend were less likely to have stopped smoking than those who did not. Both male and female adolescents who were of age 13, definitely would not/most probably would not accept cigarettes from a peer, and perceived smoking increases body weight were more likely to stop smoking We believe this is important information that public health policy makers and professionals involved in the designing and delivery of interventions aimed to prevent adolescent smoking in Ukraine need to consider in designing interventions that are not gender-sensitive.

It is interesting to note that both male and female adolescents who reported that they would definitely not accept a cigarette from a peer were more likely to have stopped smoking that those who would not. One sense, this would suggest that adolescents who are committed to no longer smoke were more successful to have stopped smoking. Alternatively, our finding may suggest that adolescents who have already quit smoking are more likely not to accept a cigarette from a peer than those who are still smoking. Due to the cross sectional design of our study, however, it is not possible to tease out which of the two explanations may be more likely. It is however obvious that comparing adolescents who have stopped smoking to those who are still smoking, those that have stopped smoking reported that they would not accept a cigarette offer from a peer more than those that are still smoking. Smoking cessation programs should seriously consider the role of peers in facilitating continued smoking in adolescents who may wish to quit.

We found that both male and female adolescents who reported having received advice on how to stop smoking from professionals or friends were less likely to stop smoking suggesting that these sources may not have regarded as credible by the adolescents; the reason partly being that some professionals also smoke cigarettes.

Findings from this study indicate that there were gender differences in smoking cessation related to the perception of the effects of smoking on reducing body weight, support or advice on how to stop smoking from a family member or lecture on the harmful effects of smoking. Previous studies have reported gender differences in responses to smoking cessation messages [13] as well as tobacco cessation interventions [14, 15].

We also assessed whether the beliefs about the effect of smoking on weight was associated with having quit smoking. In the GYTS survey adolescents had been asked whether they thought that smoking was associated with weight gain or weight loss. Adolescents who believed that smoking makes one's weight decrease were more likely to have stopped smoking among male adolescents, and less likely to have stopped smoking among female adolescents. What does this mean in the context of Ukraine? In many of the Western countries and lately in emerging economies, female adolescents in general perceive themselves to be overweight or heavy. Lean body weight is desirable. In many of these settings also, smoking is perceived as resulting in lean body weight [16–18]. Some female adolescents smoke in order to achieve or maintain a lean body weight [19, 20]. Different perceptions of body weight may be different between genders and may explain why male adolescents were more likely to stop smoking in favour of a heavy body weight.

The finding that while male adolescents who received support or advice from family members were less likely to stop smoking, and female adolescents were more likely to stop smoking suggest that female adolescents took family members as credible source of information on cessation of smoking while male adolescents did not.

We found that having had a lecture on the harmful effects of smoking was associated with having quit smoking. A meta-analysis of adolescent smoking cessation programs reported by Sussman et al [21] suggested that programs that included a motivation enhancement component, cognitive-behavioural techniques, and social influence approaches were more likely to have been successful. These authors also reported that higher quit rates were found in school-based clinic and classroom modalities and in programs consisting of at least 5 quit sessions. This finding is consistent with our finding among female adolescents who were more likely to stop smoking after having had a lecture on harmful effects of smoking. Although we do not have a description of the content, conduct, frequency and number of lectures that had been delivered to adolescents who reported to have had a lecture, it is still heartening to note that having had a lecture on the harmful effects of smoking was associated with less likelihood of having to quit smoking among male adolescents.

We have identified some factors that are associated with having quit smoking that are gender-specific. We suggest that adolescents' smoking cessation programs in Ukraine consider these factors in the design, implementation and evaluation of their gender sensitive programs guided by the FCTC that Ukraine ratified in 2006.