BACKGROUND

In August of 2004, Trinidad & Tobago ratified the Framework Convention on Tobacco

Control. The framework Convention calls for smoke-free environment in indoor public

places, indoor workplaces, public transport and other public places as deemed

appropriate.

In support of this move, The Pan American Health Organization (PAHO) embarked upon

a smoke-free pilot Project in conjunction with The North West Regional Health

Authority, the University of the West Indies, the National Parent -Teachers Association

and the Power Generation Company of Trinidad Tobago . The project aims, firstly, to

raise the awareness of the harm caused by second-hand smoke and secondly, to

emphasise the need to promote written and enforced policy requiring key sectors to

become smoke-free.

In this regard, The Coalition for a Tobacco-Free Trinidad & Tobago as the leader of the

campaign sought the cooperation of the University of the West Indies (UWI) to fulfill one

of the activities of the project, which is to conduct and publicize the results of public

opinion polls on a smoke free environment at the University of the West Indies.

The Health Service Unit of the St. Augustine Campus led the initiative to collaborate

with The Coalition for a Tobacco-Free Trinidad & Tobago to conduct a survey on the

UWI campus. The objectives of the survey were outlined as follows;

To obtain evidence on the prevalence of smoking of a sample of the student

population on the St. Augustine Campus

To obtain an understanding of the attitudes, knowledge and behaviors related to

smoking and its health impact

To assess the opinion of students towards a smoke free campus environment

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To provide information to guide in policy / programming planning in addressing

tobacco use on the campus

INTRODUCTION

CURRENT SITUATION

NATIONAL

An estimate of tobacco use among the youth in Trinidad & Tobago is difficult to

determine in light of the limited number of studies previously conducted. The Global

Youth Tobacco Survey conducted in 2000 found among their conclusions that about 40%

of all students between the ages 13-15 have experimented with cigarette smoking at one

or another; that an equal percentage of male and females are experimenting with smoking

before the age of 10; that media advertising is a major contributor; and that a major

influential factor is that they live in households where parents and other adults smoke.

Additionally, the majority felt that in order to curb exposure to environmental tobacco

smoke, smoking should be banned in public places.

INTERNATIONAL

In a 1999 national survey (N. Rigotti, JE Lee and H Wechsler Jama 2000;699-705) of

119 national four- year colleges in the United States , the primary objectives were to

assess the prevalence of all forms of tobacco use among US college students and to

identify student and college level factors associated with use. It was intended that the

study would provide the opportunity to explore the impact of Massachusetts Tobacco

Control Program on smoking by young adults. It was found that students in those

colleges use tobacco products at substantial rates and the cigarette smoking was said to be

just under 30%.

The study concluded that tobacco use was common among college students and that

colleges appeared to be the time when many students were experimenting with tobacco

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products and were susceptible to developing nicotine dependence and that Colleges

provided the opportunity for intervention to discourage tobacco use.

THE SURVEY

METHODOLOGY

Sampling

The sample size was initially based on 10% of the current (2004/2005) student population

at the St. Augustine Campus, UWI. Faculty samples were calculated based on its

proportionate ratio to total existing enrolment. On that basis, the sample population to be

targeted for each faculty was then divided equally into years 1, 2 and 3 at the

undergraduate level. The calculation resulted in a sample size 1200 students of which 200

were postgraduates.

Data on class sizes for all faculties were obtained from The Campus IT department and

this information was used for the distribution of the questionnaires. Both undergraduate

and postgraduate classes to be surveyed were then randomly selected based on the faculty

ratios.

Questionnaire

The Global Tobacco Youth Survey was chosen as the most appropriate questionnaire.

This questionnaire is available to all countries and was developed by The World Health

Organisation (WHO) in conjunction with the Tobacco Free Initiative (TFI), the United

Nations Childrens Fund (UNICEF), and the Office on Smoking and Health Centers for

Disease Control and Prevention (OSH-CDC). The questionnaire is a standard instrument

used to assess smoking prevalence and other variables related to smoking in the youth

aged 13-15.

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The questionnaire originally had fifty-six questions, but modifications were made to

make them more culturally relevant and more appropriate to the age of the students

population at the St. Augustine Campus. The revised questionnaire for the Smoking

Survey at the St. Augustine Campus comprised forty-four questions, the first eight of

which related to personal information on gender, age, ethnicity and status at UWI. The

remaining questions dealt with experience, knowledge and opinions towards smoking,

exposure to smoking, and attitudes toward stopping smoking and a smoke free

environment on the campus.

The questionnaires were distributed to classes by field officers and self administered by

respondents. Questions had response categories, which had to be ticked off. Multiple

responses to any question were not allowed and participation was voluntary and

anonymous.

Data Collection

The distribution of the questionnaires was handled by students who were hired

specifically to administer the questionnaires, give a brief introduction to the survey,

collect and collate them and return them to the project coordinator.

Analysis

The Database manager and an assistant entered data into the Access database for the

creation of queries and reports. The Project Coordinator analysed the data, which formed

the basis of the observations and trends that were highlighted. The limitations of the

analysis were also discussed and proposed action for follow up was identified.

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RESULTS

A total of 1165 students of the 1200 students targeted on the St. Augustine Campus, UWI

undertook to participate in the survey. This yielded a 97% response rate. The sample

included students across the five faculties, and from all three levels of study. All 1165

respondents did not however, answer all the questions. For the purpose of this paper the

sample population decided upon was based on 1144 respondents. These respondents

however, all answered the question, which was used to determine current smokers from

non-smokers.

Characteristics of the sample

Of the 1144 respondents, 90% were undergraduates and 10% were postgraduates. The

distribution of the respondents by faculty was as follows; Education 4.47%, Engineering

16%, Humanities 17.0%, Law 2.2%, Medical Sciences 7.6%, and the majority from

Science and Agriculture 30% and Social Sciences 25%.

In terms of gender distribution, approximately 40 % were male and 60% female, 52% of

the sample was between the ages 18-21, 27% between 22-25 and 20% over 25. In terms

of ethnic background, 39 % was of Indian origin, 35% African, 22% of mixed races and

4% of Chinese, Spanish, Syrian and other ethnicities.

Eighty-nine percent of the sample population was single and 10% percent married. The

majority of the students (85%) were registered as full-time and 38% were in level 1 (or

first year), 32% in level 2, 25% in level 3. Less than 3% were in levels 4 and 5 and this

comprised mainly students in the faculty of Medical Sciences.

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Experimentation with smoking

Students were asked whether they had ever tried or experimented with cigarette smoking,

even one or two puffs, the results indicated that 567 or 49% of the respondents answered

positively, of which 53% were female and 43% male. From the base of the sample

population, the majority of students who admitted to having experimented with smoking

came from Science and Agriculture (26%) and Social Sciences (26%), Engineering

(16%) and Humanities (16%) and 45% were in the age group 18-21.

7

Chart 1 Experimentation with Smoking

0

10

20

30

40

50

60

Per

cent

age

Female

Male

Female 26.4 33.3

Male 23.1 16.8

Yes N o

Chart 2 -Experimentation with Smoking

0

1

2

3

4

5

6

7

8

9

Education Engineering Humanities Law MedicalSciences

Sciences SocialSciences

Per

cen

tag

e

Female

Male

8

Prevalence of smoking

In order to assess the prevalence of smoking on the campus, the methodology defined

current smokers, as students who had smoked cigarettes on one or more occasion within

the last thirty days. 122 students or 11% of the respondents were identified as current

smokers. More males (64%) were current smokers than females (36%). Thirty-seven

percent of respondents indicated that they were 16 years or older when they first tried a

cigarette, inferring that most students first tried smoking under 16 ( 26% of whom were

between 14-15).

Current smokers

The highest percentage of current smokers were in the faculty of Science and Agriculture

with 27%, Engineering with 24% followed by Social Sciences 21%, Humanities 13%,

Medical Sciences 8%, Education 2.5% and Law 1.6%. More students from the younger

age group18-21 were current smokers (56%), about 28% were between the ages 22-25

and 11 % over 25.

Smokers were also assessed in terms of their ethnic background. According to the data

response persons of Indian background smoked most (51%), others were of mixed races

( 26%), and Africans at 19%. Smokers of Chinese, Spanish, Syrian and other ethnicities

comprised 2.4%.

Many of the current smokers (27%) said that they most smoked at social events, less at

home (22%) and the least at school (17%). The majority of students who were smokers

(83%) mainly chose cigarettes as their only form of tobacco use.

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Table 1 : Experimentation and Prevalence

Category Experimentation

Prevalence Current smokers

First Smoked Cigarette before age of 16

Total 49.5 10.7 13.0

Male 46.5 63.9 14.6 Gender Female 53.2 36.0 13.1

Engineering 16.2 23.8 6.3

Education 5.3 2.5 0.7

Humanities 15.9 13.1 4.2

Law 1.4 1.6 0.3

Medical Sciences

8.1 8.2 2.5

Science & Agriculture

25.6 27.0 7.0

Faculty

Social Sciences

25.6 20.5 7.2

25 23.8 11.5 5.6

Age

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Chart 3 -Current smokers by Gender & Faculty

0

10

20

30

40

50

Per

cen

tag

e

Male

Female

Male 0.0 23.0 7.4 0.0 4.9 16.4 9.8

Female 2.5 0.8 5.7 1.6 3.3 10.7 10.7

Education Engineering Humanities Law Medical Sciences Sciences Social Sciences

Chart 4-Current Smokers by Gender& Ethnicity

0

10

20

30

40

50

60

Per

cen

tag

e

Male

Female

Male 0.8 31.1 17.2 13.1 0.8 0.0

Female 0.0 19.7 9.0 5.7 0.0 0.8

Chinese Indian Mixed African Spanish Syrian

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Chart 5 - Current Smokers by Gender & Age

0

10

20

30

40

50

60

70P

erce

nta

ge

Male

Female

Male 0.8 36.9 20.5 4.9

Female 0 21.3 7.4 7.4

>18 18-21 22-25 >25

Chart 6 - Current Smokers by Gender & Level of Study

0

5

10

15

20

25

30

35

40

45

50

Per

cen

tag

e

Male

Female

Male 15.6 23.8 18.9 2.5 0.8

Female 13.1 13.9 8.2 0.0 0.8

Year 1 Year 2 Year 3 Year 4 Year 5

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Frequent Smokers

Students who smoked cigarettes on 20-30 days of the month were considered frequent

smokers. Approximately, 40% of the current smokers were frequent smokers with the

highest percentage of frequent smokers being in Engineering and Science and Agriculture

at 28% each. There were more male frequent smokers (73%) as compared to female ones

(27%). Some 28% claimed to be casual smokers or those smoking only on one or 2 days

of the month. At least 51% of the smokers indicated that they smoked anywhere from 2

to 10 cigarettes a day.

Age of first attempt with smoking

When asked how old they were when they first tried a cigarette, 54% stated that they

were between 10-15, 37% indicated that they were 16 or older and only 8% of the current

smokers said they were younger than 10.

Knowledge and Attitudes Towards Smoking

The question was posed to current smokers as to whether anyone in the family had

discussed the harmful effects of smoking with them. It was concluded that more smokers

(63% of which 69% were male) than non-smokers (47% of which 66% were female)

indicated that they did have discussions.

In response to question as to whether they thought smoking cigarettes helped people feel

more or less comfortable at celebrations, parties, or in other social gatherings, both

current smokers and non- smokers equally believed that it made people feel more

comfortable.

In general, the majority of respondents believed that smoking was harmful to ones

health. Among the current smokers, 73% (of which 60% male) indicated that it was

definitely harmful, and as predicted, many more of the non-smokers (93% of which 64%

were female) shared the same opinion.

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When asked about their impressions of a man smoking, the majority of the results

indicated that the respondents had negative impressions. Seventy-five percent of the non-

smokers indicated that they thought the man was stupid, lacking confidence and felt they

were losers. However less of the smokers (22%) shared the same view.

In reference to a woman smoking, more non-smokers (83%) than smokers (34%) felt

women lacked confidence, were losers or were stupid.

Chart 7 Attitudes towards Smoking

0102030405060708090

100

Think smoking is harmful toone's health

Think smoking makes peoplefeel comfortable

Think smoke from other people'scigarettes is harmful

Per

cen

tag

e

Current smokers

Non-smokers

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Table 2 : Knowledge and Attitude

Think smoking makes people feel more comfortable

Think smoking is definitely harmful to ones health

Has negative impressions of man who smokes

Has negative impressions of a woman who smokes

Category

Current smokers

Non-smokers

Current smokers

Non-smokers

Current smokers

Non-smokers

Current smokers

Non-smokers

Total 40.9 42.0 73% 92.5 35.2 74.6 22.1 82.6

Male 30.3 14.5 45.9 32.7 15.5 26.0 25.4 29.3 Gender

Female 10.6 27.2 27.0 59.5 6.5 48.4 9.8 53.0

Engineering 11.5 7.0 15.6 13.6 4.1 10.8 9.8 12.2

Education 0.8 0.0 2.5 4.2 0.8 3.3 0.8 3.5

Humanities 4.1 7.0 9.8 15.8 2.5 13.5 4.9 14.9

Law 0.8 1.1 0.8 2.3 0.0 2.0 0.0 2.1

Medical Sciences

4.9 4.0 4.9 7.2 1.6 6.0 3.3 6.3

Science & Agriculture

9.0 10.6 18.9 25.3 4.9 20.0 8.2 22.9

Faculty

Social Sciences

7.4 9.8 18.0 23.0 6.6 18.5 6.6 19.9

25 3.3 7.5 6.6 18.8 1.6 15.3 1.6 16.6

Age

Social Influence

It was found that 23% of the students who were surveyed had parents who smoke. More

current smokers (38%) indicated that either one or both of their parents smoke, but of the

non-smokers less of them (22%) said that their parents smoke.

In reference to the question about having close friends who smoke, it was found that the

majority (97%) of the current smoker respondents replied positively, 64% of which were

males. Contrastingly, less of the close friends (53%) of the non-smokers were smokers.

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Chart 7 -Social Influence

0102030405060708090

100

Have parents who smoke Have close friends whosmoke

Harmful effects of smokinghas been discussed in the

family

Per

cent

age

Current smokers

Non-smokers

Exposure to Smoking

The belief that smoke from other peoples cigarettes was harmful was felt by 84% of the

sample population on the whole but more non-smokers (87%) compared to current

smokers (62%) agreed with this view.

Students were also asked to respond to whether or not they were in favour of banning

smoking in public places (restaurants, buses, schools, playgrounds, gyms, sports arenas

discos etc.) The general response from the sample population suggested that 85% (63%

female, 31% male) were agreeable to banning smoking in public places. Only 41% of the

current smokers said yes to banning smoking in public areas. Among the non-smokers

ninety percent of the respondents were more inclined to banning smoking in public places

and more females (64%) than males (35%) supported the choice.

Student opinion on banning smoking in designated student areas on the campus was also

assessed. The data indicate that overall, a majority of 88% of the sample population (62%

female and 38% male) preferred smoking to be banned on the campus. At a closer

analysis, a greater proportion (93%) of the non-smokers favored a smoke free campus

while only 52% of the current smokers supported that option.

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Chart 9- Exposure to Smoking

0102030405060708090

100

Exposed to smoke athome

Exposed to smokefrom other places

than home

In favour of banningsmoking in public

places

In favour of banningsmoking on the

campus

Per

cen

tag

e

Current smokers

Non-smokers

Table 3 : Exposure to Smoking

Exposed to smoke from others at home

Definitely think smoke from others is harmful to them

Percentage who think smoking should be banned in public places

Percentage who think smoking should be banned in student areas on Campus

Category

Current smokers

Non-smokers

Current smokers

Non-smokers

Current smokers

Non-smokers

Current smokers

Non-smokers

Total 59.8 30.0 63.0 87.0 40.9 90.1 52.4 93.0

Male 43.4 11.9 39.3 30.4 16.4 32.2 30.3 33.5 Gender

Female 16.4 18.0 23.0 56.4 24.5 57.7 22.1 59.2

Engineering 14.8 4.8 14.8 12.9 9.8 15.1 9.8 15.2

Education 2.5 1.2 1.6 4.0 1.6 4.5 1.6 4.6

Humanities 7.4 5.3 9.0 15.3 4.9 17.1 6.6 17.1

Law 0.8 0.4 0.8 2.0 0.8 2.2 0.8 2.3

Medical Sciences

6.6 2.8 2.5 6.5 1.6 7.5 1.6 7.5

Science & Agriculture

19.7 8.9 17.2 24.0 8.2 27.1 17.2 27.1

Faculty

Social Sciences

6.6 6.3 13.9 21.3 12.3 25.0 12.3 25.0

25 7.4 5.1 4.1 18.3 2.5 19.7 4.1 19.9

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Intention to smoke / Desire to stop.

The non-smokers indicated that only 3% of them would definitely smoke if one of their

best friends offered them a cigarette, the majority of whom were females (71%).

However, less than 2% of them thought that they would be smoking cigarettes 5 years

from now.

Just about 34% of the current smokers indicated that they wanted to stop smoking but

more males (74%) than females showed this desire. Thirty-six percent of those who

indicated a desire to stop smoking was from the faculty of Science and Agriculture but

of the 39% who said that they did not want to stop smoking, at least 31% was students

from Engineering.

Of the smokers who responded, 46% indicated that they had stopped smoking (61%

males 39% females) and 41% stated that they had stopped anywhere between 1 to 11

months.

Only 16% of the current smokers ever received help to stop smoking, and 36% of those

who said they had stopped indicated that improving their health was the main reason for

doing so.

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DISCUSSION

Observations

At least 50% of all the respondents had experimented with smoking at one time, but more

females (53.2%) than males (46.5%) had tried smoking. It is also evident that more

persons in the younger age group 18-22 had tried their first cigarette before the age of 16.

The habit of smoking was more prevalent among the male gender as 64% of the current

smokers were male and 36% female. Students in the age group 18-21 comprised most

(58%) of the current smokers.

Frequent smokers were defined as those who smoked on all of the 30 days. The

percentage of frequent smokers among the current smokers was found to be significantly

high at 33% (75% percent of whom are male).

Students were divided on the issue of whether smoking made people feel comfortable,

42% believed it made people feel more comfortable, 42% said there was no difference

and 11% indicated that it made people feel less comfortable. Persons who had close

friends who smoked also tended to be smokers as distinct from non-smokers who had less

close friends who smoked. At least 65% of the respondents were not exposed to other

peoples smoke in their homes but 73% claimed that they were exposed to other peoples

smoke in places other than their home anywhere from 1 to 7 days. In the male dominated

faculty of Engineering smoking tended to be more acceptable and there was more

reluctance from them to stop smoking.

An overwhelming 90% of the sample population agrees that smoking is definitely

harmful to ones health, while 84% think that smoke from other peoples cigarettes is

harmful to them. The consensus (85% of the sample population) on the campus is that

smoking should be banned in public places and more believe (88%) that this should be

extended to student areas on the campus. It must also be recognised that a significant

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proportion of the student sample have articulated a desire to stop smoking but

interestingly less females have indicated this will.

Limitations

The analysis of the survey was restricted to the extent where students failed to complete

responses to some questions. Although the questionnaire included a wide range of

questions regarding the use, attitude, beliefs, influence and exposure to smoking, the

analysis was limited to a selected number of questions, focusing on the prevalence and

experience in smoking behavior and attitudes of the student population towards a smoke

free campus. Responses were few in number at the postgraduate level and not evenly

distributed and they were therefore considered to be too few to lend significance to the

study.

Some answers were ambiguous and this created a difficulty in the analysis particularly as

it was related to the response, I have never smoked cigarettes which was identified as a

response in more than one question. In all instances the numbers responding were

different.

This survey is the first of its kind to be conducted on the campus and therefore

comparisons could not be drawn to measure any change in the pattern of smoking nor the

profile of smokers. The existing national survey entitled, Global Youth Tobacco

Survey conducted in 2000 by the Ministry of Health dealt mainly with the target age

group 13-15 in 61 schools across the country. While the report concentrated on a

younger survey population, it was able to conclude that cigarette smoking was a cause for

growing concern and that among those surveyed at least 40% has smoked cigarettes once

in their lives.

Comparative Data

In the final report of the task force on a smoking survey (June 2004) conducted at the

three campuses of the University of New Brunswick, Canada, it was noted that

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approximately 16% of the 1144 student respondents smoked. The trends have been

similar to the study at UWI in that, about 40% have thoughts of quitting while 98% were

aware of the health issues related to smoking and 92% were concerned about the effects

on their health.

Across the three campuses there were general encouragement for added measures to

reduce smoking on the campus ranging from 75% to 85% and 60% to 70% backing for

the total ban on smoking on the campuses.

At the California State University Sacramento, California, US, results of a 2003 survey of

1155 respondents demonstrated that there was a decline in the percentage of students who

were smokers from 32% in 2001 to 15% in 2003. The issue of secondhand smoke was a

main concern to 60% of the survey respondents while 52% indicated that it was important

to have campus designated smoking areas.

Conclusions

It has been observed that while only 11% of the students have admitted to being current

smokers the practice of smoking is more common among the younger age group 18-21,

which represented 56% of the smokers, and at least 43% of this age cohort indicated that

they first smoked a cigarette under the age of 16.

There was a higher ratio of smoking among the male population and those in the

faculties of Science and Agriculture and Engineering and also among students registered

in level two and from Indian ethnicity. There was less occurrence of smoking among

persons of African and Mixed descent. There was also a higher incidence of smokers

among those who had parents and or close friends who smoked.

Exposure to environmental smoke is a growing concern among the student population.

Opinion on the harmful effects of smoking to ones health and from other peoples smoke

and tend to be stronger among the non-smokers and there is also overwhelming support

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for banning smoking in public places and select student areas and the campus. Notably,

there is also considerable support from the smoking population for the creation of a

smoke free campus.

The information from the smoking students indicates that there is a receptiveness towards

quitting smoking and similarly and a greater inclination from them to having tried stop

smoking cigarettes in the past year. A significant proportion (38%) have claimed that

they have never received help nor advice to help them stop smoking, it seems therefore

that this is an opportunity for the campus to foster programmes to assist those who are

partial to giving up the habit.

It is safe also to assume from the available data that less than 20% of the persons

identified as nonsmokers, would ever begin to smoke.

Follow-Up

As part of the objective of this survey, it is important to acknowledge the indicators of

the sample population as representative of the campus body. Smoking is evidently

unpopular and the general feeling is that environmental smoke is unwanted. There is also

strong advocacy for mechanisms to be put in place for establishing smoke free student

areas on the campus in support of the general consensus.

The survey has been able to identify where and with whom, the prevalence of smoking is

greatest. There must therefore be more surveillance in terms of programmes and policies

to be developed for smoking cessation and for the intervention required to discourage

smoking and other forms of substance abuse especially where the use patterns are related

One item for follow up is the commitment to repeat similar surveys in the future for the

continuous monitoring of the habitual trends of the student population in tobacco and

other forms of substance use.

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References

1. The Ministry of Health, Directorate of Health Policy , Research and Epidemiology, B.

Carr, L. Alleyen and D. Renaud Global Youth Tobacco Survey. June 2000.

2. N A Rigotti, S Regan, N E Majchrzak, J R Knight and H Wechsler, Tobacco Use by

Massachusetts Public College Students: long term effect of the Massachusetts Tobacco

Control program. Tobacco Control 2002;11(Suppl 11) ii 20- ii24

3. P. Bovet, B Vishwanathan, W. Warren, Ministry of Health , Victoria , Seychelles, The

Global Youth Tobacco Survey in the Seychelles 2002.

4. International Union against Cancer (UICC) & Tobacco Control Resource Centre, J.P

Pierce, Conducting a smoking prevalence survey. (http://

factsheets.globallink.org/en/prevalence.

5. Statistics Canada: 2002 Youth Smoking Survey.

6. D. Wybou , A Final Report of a Task Force on Smoking Survey, The University of

New Brunswick, June 2004. Submitted to the UNB Joint Health and Safety Committee.

7. Survey of the California State University 2003. www.sacstand.org/survey