CURRENT SITUATION OF SMOKING AND THE RISKS AFFECTING MENTAL HEALTH OF HIGH SCHOOL STUDENTS IN HANOI

ABSTRACT

Objective: To describe the current status of smoking among high school students in Hanoi and analyze some relationships between smoking behavior and the risk of affecting mental health of this group.

Materials and methods: The cross-sectional study of 334 students attending high school at educational establishments in Hanoi city. Purposive random sampling method. Of which, grade 10 students are 98 students, accounting for 29.3%, grade 11 students are 78 students, accounting for 23.4%, and grade 12 students are 158 students, accounting for 47.3%. There are 182 students in ctiy areas, accounting for 54.5%, and 152 students in rural areas, accounting for 45.5%.

Results: 19.3% of students have ever tried tobacco at the age of 15 years old. Research has found a link between smoking behavior and mental health risks, with varying degrees of anxiety, depression and stress. In addition, seeing people smoking in school and being introduced to cigarettes by friends and relatives increases the smoking rate of students. It is necessary to continue to coordinate closely between health agencies, educational institutions and local departments and unions in communication work to reduce the harmful effects of tobacco among high school students.

АННОТАЦИЯ

Цель: описать текущую ситуацию с курением среди старшеклассников в Ханое, и проанализировать взаимосвязь между курительным поведением и риском воздействия курения на психическое здоровье данной группы. Объекты и методы: перекрестный анализ 334 учащихся, посещающих среднюю школу в образовательных учреждениях города Ханой. Использован метод целенаправленной случайной выборки. 98 человек - учащиеся 10 класса, что составляет 29,3%, 78 человек - учащиеся 11 класса, что составляет 23,4%, и 158 человек - учащиеся 12 класса, что составляет 47,3%. В городских районах учатся 182 ученика, что составляет 54,5%, и 152 ученика - в сельской местности, что составляет 45,5%. Результаты: 19,3% учащихся когда-либо употребляли табак, при этом средний возраст первого употребления составил 15 лет. Исследования выявили связь между курением и рисками для психического здоровья, которые проявляются в различной степени тревожности, депрессии и стресса. Кроме того, наблюдение за курящими людьми в школе и знакомство с сигаретами благодаря друзьям и родственникам повышает уровень курения среди учащихся. Необходимо продолжать тесную координацию между учреждениями здравоохранения, образовательными учреждениями и местными департаментами и профсоюзами в коммуникационной работе по снижению вредного воздействия табака на учащихся старших классов.

Keywords: Smoking, high school students, mental health, risk, Hanoi.

Ключевые слова: курение, старшеклассники, психическое здоровье, риск, Ханой.

1. Introduction

Tobacco use is the world’s leading preventable cause of death and one of the greatest public health threats the world has ever faced. Smoking is now considered a ‘silent epidemic’ [1]. During the 20^th century, the tobacco epidemic killed 100 million people worldwide. Every year 5.4 million people die, with an average of one person dying every 6 seconds and accounting for 1/10 of all adult deaths worldwide. If left unchecked, the death toll could rise to more than 8-10 million people per year by 2030, and 70-80% of those deaths will occur in developing countries. There are about 1.3 billion smokers in the world; about 80% of them live in developing countries. According to estimates by the World Health Organization (WHO), about 47% of men and 12% of women smoke worldwide; in developing countries, 48% of men and 7% of women smoke, while in developed countries, 42% of men smoke compared to 24% of women [2].

Tobacco use is a serious problem among adolescents. The link between lung cancer, chronic obstructive pulmonary disease, mental health and smoking has been shown in various studies [3]. On the other hand, smoking is spreading rapidly among young people in developing countries, including Vietnam. Concomitant with the psychological changes and risk-taking behavior observed in adolescence, tobacco use rates are increasing. Statistics from the US show that 20% of teenagers smoke [4]. To develop effective strategies to combat this harmful addiction, it is essential to know why adolescents start or continue to smoke. This study was designed to evaluate smoking behavior and the association between smoking behavior and mental health risks in a representative sample of high school students in Hanoi. It is clear that smoking is a complex health problem with many interwoven factors, social, environmental, behavioral or innate factors influencing the smoking status of adolescents. This is an important stage in the formation of smoking habits, most smokers start smoking during adolescence or early adulthood, usually a period of about 1.5 to 2 years from birth. from starting to smoke until forming a smoking habit. Adolescence is a time in life when people are more interested in taking risks and testing the boundaries of the world as well as their own limits. Going to school is the main activity for most children and school is where most children first integrate and where they acquire a lot of knowledge, form attitudes and sometimes even habits [5].

2. Research results

2.1. Prevalence of traditional cigarette smoking among high school students

Smoking is one of the serious threats to health in general and mental health in particular. According to the World Health Organization (WHO), tobacco can kill more than 8 million people each year, approximately half of all users, and more than 7 million deaths are the result of direct cigarette smoking. There are approximately 942 million men and 175 million women aged 15 years and older who use tobacco. Long-term health consequences caused by smoking include the risk of respiratory and cardiovascular diseases, and even the risk of cancer. Studies on the rate of tobacco use among young people and teenagers in Vietnam show that the smoking rate among young people and teenagers is increasing and the age of starting to smoke is getting younger and younger

Research results show that out of a total of 334 subjects surveyed, 65 students are using cigarettes/pipe tobacco (traditional cigarettes), accounting for 19.3%. This rate is higher than Lim KH's (2017) study of 14.6%, (Lim, K.H., et al, 2017). However, when compared with SAVY II, it shows that ever smoking is significantly higher (19.3% compared to 10% of SAVY II in 2009). This may be because the measures taken to solve the problem of smoking in Vietnamese adolescents are not comprehensive and thorough compared to population growth or social evils.

Figure 1. Rate of tobacco use among high school students in Hanoi

- Correlation between gender and living area on smoking behavior

Research results show that tobacco use behavior between genders has a statistically significant correlation (p<0.05). Men use tobacco more than women. It is worth mentioning that 6.8% of women use tobacco. The use of tobacco by female students in the past was associated with many gender stereotypes, and society found it difficult to accept the image of women smoking, but now the problem. So many women use cigarettes to show their sophistication, experience, and conformity to their peers.

Table 1.

 Correlation between gender, grade level, and living area on tobacco use among high school students in Hanoi today

Comparing smoking behavior between grades and living areas, there was a statistically significant difference (p<0.05). Students in grade 12 use tobacco at a higher rate (13.4%) than students in grades 10 and 11. This is also partly because when students move to high school, they can be exposed to more. than among older peers or social groups where tobacco use is more common. Furthermore, students in grades 11 and 12 often have more autonomy and freedom than previous grades. The pressure of coursework and college applications can contribute to increased stress in students in higher grades. Some may turn to tobacco use as a coping mechanism to cope with academic pressure.

Data show that smoking behavior among students and living areas has a statistically significant difference (p<0.05). Specifically, among the 65 students who use tobacco, 48 students in urban areas use tobacco, accounting for 12.3%, while the rate of tobacco use in rural areas is 6.9%. Tobacco use by students in urban areas is higher than that of students in rural areas because urban areas have easier access to tobacco products due to more stores and more advertisements. This ease of access may contribute to increased urban tobacco use. Some students in urban areas may turn to smoking as a coping mechanism for stress or as a way to fit into certain social groups. And societal attitudes toward tobacco use may differ between urban and rural areas. In some urban environments, smoking may be more socially acceptable or seen as a symbol of adulthood or independence.

2.2. The age of first tobacco use among high school students in Hanoi

Our research found that high school students who used tobacco for the first time ranged from 11 to 16 years old, accounting for 78.4% (of which first tobacco use was from 11 to 13 years old and from 14 to 16 years old), the age accounts for 39.2%. However, it is worth mentioning that 3.8% of students who first use tobacco are under 10 years old. The early use of tobacco by students may be partly influenced by their peers. Besides, due to misconceptions and lack of awareness about the risks associated with tobacco use, there is another factor that must be mentioned. Students from lower socioeconomic backgrounds may be more likely to initiate tobacco use at a younger age due to a variety of stress factors or lack of access to resources that may discourage tobacco use in high school students.

Figure 2. Age of first tobacco use of high school students

All interview participants have ever used or are currently using tobacco. The first time they smoke is at around the age of 14-16, but they start smoking regularly a few years later, most often with certain groups of friends outside of school, groups of friends at school.

“I tried smoking for the first time at the end of high school. At that time, it happened very periodically, right from the beginning of staying with friends. However, now when the pressure of studying may be that I start to smoke a lot. . . I can't imagine my morning without smoking. Now, I have this habit. . . you eat breakfast and immediately crave the desire to smoke. I also smoke about 5-10 cigarettes, maybe even more every day” (Male, 12th grade student, citty)

 “Currently, I feel that people using tobacco is a trend, especially boys, there are also a few girls who also use cigarettes. If you do research in some average schools, you will observe how much they smoke" (Female, 11th grade student, city)

Table 2.

 Correlation of age at first tobacco use of high school students with area of residence

Data show that the age of first smoking among high school students in urban and rural areas has a statistically significant difference (p<0.05). The age of first tobacco use in urban areas ranges from 11-13 years old (17.6%), while in rural areas it accounts for 21.6%. In addition, the age of tobacco use in urban areas is from 14-16 years old (28.4%), while in rural areas (10.8%). Students in urban areas who use tobacco over the age of 17 account for 13.5%, and 4.1% in rural areas.

2.3. The relationship between tobacco/pipe tobacco use behavior affects the mental health of high school students

Research results show that, out of 65 tobacco users, 14 are at risk of anxiety and 14 are at risk of stress, accounting for 4.2%. There are 11 people at risk of depression, accounting for 3.3%. Thus, the use of cigarettes/pipe tobacco has the risk of affecting the mental health of high school students to varying degrees.

Table 3.

 Relationship between smoking/pipe tobacco behavior and mental health of high school students

Qualitative research results show that some opinions agree on the risks of smoking leading to mental health problems, specifically anxiety, depression and stress. This is expressed in some comments as follows:

‘I smoke regularly, normally I smoke nearly a pack a day, I am considered a smoker. There are times when I smoke too much and feel tired, dizzy, and sometimes have insomnia.’ (Male, 12^th grade student, city)

‘I find that every time I smoke, I feel refreshed and work more effectively. But sometimes I feel like I have no energy left, I can't concentrate on anything, sometimes causing a feeling of stress and worry about my studies and future.’ (Male, 11^th grade student, rural area)

 ‘I think smoking can harm our health and affect ourselves and everyone around us. I heard a lot about the dangers of tobacco use affecting mental health, sometimes even leading to problems with tuberculosis, lungs, heart disease, and cancer.’ (Female, 12^th grade student, rural area).

Through discussions with a number of experts, most opinions believe that smoking seriously affects health, not only causing many dangerous diseases but also affecting mental health. Smokers will have feelings of restlessness, discomfort, irritability, anxiety, decreased concentration, depression, and insomnia. Smokers will often have insomnia, difficulty sleeping, sleep more, and be more tired in the morning. In addition, opinions also show that smoking is associated with reduced self-esteem, increased anxiety symptoms and reduced ability to adapt to stress. Negative emotions, suicidal thoughts, increased behavioral disorders such as attention deficit hyperactivity disorder; gambling addiction; impulsive and impulsive behaviors; illegal acts.

- Gender attitudes about tobacco use behavior affect students' mental health

The data table shows that the correlation between men and women in tobacco use affects mental health.

Table 4.

 Gender relationships about tobacco use behavior affecting students' mental health

Research results show that men who use tobacco often experience higher levels of depression and stress than women. Specifically, out of 65 tobacco users, 8 had depression problems, accounting for 3.1% and 3.7% were women. Next, 12 men had stress problems, accounting for 4.7%, of which 2.5% were women. The results also show that women often have higher anxiety problems than men when using cigarettes/e-cigarettes.

- Neighborhood concerns about tobacco use behavior affect students' mental health. Students in urban areas have higher problems with anxiety, stress and depression than students in rural areas when using tobacco. (Table 6)

Table 5.

 Area of residence concerns about tobacco use behavior affecting students' mental health

Specifically, when using tobacco, 9 students in urban areas have anxiety problems, accounting for 5.4%, of which 3.0% of students in rural areas have anxiety problems. And 4.8% of students in urban areas have depression when using tobacco and 1.8% of students in rural areas have problems with depression when using tobacco. In addition, students in urban areas have a higher rate of stress problems than students in rural areas when using tobacco at a higher rate (5.4% and 3%, respectively).

- Grade level concerns about tobacco use behaviors that pose a risk to students' mental health

The results show that 12th grade students are at a higher risk of experiencing some symptoms of anxiety, depression and stress when using tobacco than 10th and 11th grade students. Results Table 6 shows:

Table 6.

 Grade level relationships on tobacco use behavior affecting students' mental health

Table 6 shows that students in grades 10 and 11 are at risk of experiencing some symptoms related to anxiety, depression and stress at a rate of less than 3%. Meanwhile, 12th grade students are at risk of having problems with anxiety, depression and stress when using tobacco, accounting for 6.2%, 6.2% and 6.8% respectively. However, this result did not have a statistically significant relationship between tobacco use affecting mental health problems (p < 0.05).

3. Conclusion

The current smoking rate among high school students in Hanoi is alarming. The main factors determining smoking in high school students are age and family history of smoking. The results of this study indicate the need for an effective tobacco control program and policy in high schools in Hanoi. The high smoking rates currently observed indicate the need for smoking control policies in school settings, and together with the young age of smoking initiation indicate the need to develop a Effective anti-smoking program for school age students in the first years of school to prevent smoking and raise awareness about the harmful effects of smoking on health. It is recommended that the factors identified in this study be considered in programs to make them more effective and better able to influence the attitudes and behavior of smokers. The Ministry of Education and Training should apply smoking cessation programs in all primary and secondary schools. In addition, the media can help by disseminating the message of quitting smoking to the entire population. There is a need to ban smoking in public places and schools, and even anti-smoking laws that impose taxes on tobacco import or production and ban tobacco advertising can also be considered to implement an anti-smoking program.

References:

1. International Consultation on Tobacco and Youth - What in the World works? Final Conference Report Available from: http://www.who.int/tobacco/resources/pu blications/ what_works/en/index.html/; accessed August 13, 2009.
2. Shafquat R, Zahid AB, Saeed A. Correlates of cigarette smoking among male college students in Karachi, Pakistan. BMC Public Health 2007; 7: 312
3. Ferrucci L, Izmirlian G, Leveille S, Phillips CL, Corti MC, Brock DB, Guralnik JM. Smoking, physical activity, and active life expectancy. Am J Epidemiol 1999; 149:645– 53.
4. Kolbe LJ, Kann L, Collins JL. Overview of the youth risk behavior surveillance system. Public Health Rep 1993;108(Supp 1):2–10
5. Chaloupka FJ. Contextual factors and youth tobacco use: Policy linkages. Addiction 2003; 98: 147-9.