Factors promoting initiation of cigarette smoking among adolescents in rural and urban areas in Oyo state, Nigeria

Background Nigeria is a signatory to the WHO Framework Convention on Tobacco Control (FCTC) and the Tobacco Control Bill was signed in 2015. In spite of these, there are indications that many adolescents still smoke cigarettes. Our aim was to determine factors associated with initiation of cigarette smoking among adolescents in rural and urban locations in Oyo state, Nigeria. Methods This cross-sectional study utilized a mixed-methods approach. The quantitative survey involved 1142 adolescents selected by multi-stage sampling. The qualitative enquiry employed life history interviews conducted among 64 purposively-selected adolescents. Descriptive and analytic statistics were conducted. Qualitative data was analyzed using ATLAS.ti. Results The adolescents' mean age was 16±1.8years, 56.0% were male and 51.1% were currently schooling. Forty-nine (4.3%) had ever initiated smoking (i.e. smoked a whole cigarette). Mean age at smoking initiation was 15±2.2 years. About 82% of adolescents typically purchased single sticks of cigarettes which usually cost N5.00-N100 (USD0.01 - USD0.28) each. Factors predictive of initiation of cigarette smoking were urban (6.5%) versus rural (2.1%) residence [OR=2.62, CI:1.22 - 5.62]; living with friends (33.3%) versus living with parents (2.5%); [OR=8.49; CI:1.92 - 37.51] and currently being out-of-school (8.1%) versus being in-school (0.7%); [OR=4.68 CI:1.52 - 14.39]. Inadequate parental supervision, especially in childhood was also contributory. Community level factors promoting initiation of cigarette smoking were ready access of cigarettes to minors in terms of low cost, uninhibited sale of sticks of cigarette and sales to minors. Conclusions Factors promoting initiation of cigarette smoking by adolescents abound in the study area. Efforts to enhance implementation of the FCTC and the tobacco control bill at community levels are urgently needed. Interventions targeting parents and interventions to encourage adolescents to remain in school could also be beneficial in reducing initiation of cigarette smoking and ensuing problems among adolescents in the study area