Objective: To estimate the extent to which susceptibility
to smoking is associated with between-context differences
(schools and classes) and to identify factors at
school, class and individual levels that influence individual
susceptibility to smoking among young never-smokers in
South East Asia.
Methods: Cross-sectional data from the Global Youth
Tobacco Survey conducted in Cambodia (2002), Laos
(2003) and Vietnam (2003) are used to conduct multilevel
analyses that account for the nesting of students in
classes and classes in schools. The outcome variable is
smoking susceptibility, defined as the absence of a firm
decision not to smoke. Explanatory variables include
school-level (current tobacco use prevalence in school,
exposure to anti-smoking media messages and exposure
to tobacco billboard advertising), class-level (classroom
prevention) and individual-level influences (parents’ and
friends’ smoking behaviour, knowledge of the harmful
effects of and exposure to secondhand smoke at home,
age, sex and pocket income).
Results: Multilevel analyses indicate that 4.5% and 4.2%
of the variation in smoking susceptibility is associated
with school and class differences, respectively. Students
who have parents or friends who smoke, who are
exposed to secondhand smoke at home and those who
have access to pocket income are found to be more
susceptible while greater knowledge of the harmful
effects of secondhand smoke appears to diminish
susceptibility to smoking. For girls only, billboard tobacco
advertising increases the risk of susceptibility and
classroom prevention decreases risk while for boys only,
attendance at schools with higher prevalence of tobacco
use increases risk of susceptibility and anti-smoking
media messages decreases risk.
Conclusions: This study highlights a number of
modifiable factors associated with smoking susceptibility
and identifies interactions between teen sex and several
factors associated with the susceptibility to smoking. This
finding provides support for the call to move beyond
gender-blind tobacco control policies.