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Olalekan A. Ayo-Yusuf, Bukola G. Olutola, Israel T. Agaku, Permissiveness toward tobacco sponsorship undermines tobacco control support in Africa, Health Promotion International, Volume 31, Issue 2, June 2016, Pages 414–422, https://doi.org/10.1093/heapro/dau102
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Abstract
School personnel, who are respected members of the community, may exert significant influence on policy adoption. This study assessed the impact of school personnel's permissiveness toward tobacco industry sponsorship activities on their support for complete bans on tobacco advertisements, comprehensive smoke-free laws and increased tobacco prices. Representative data were obtained from the Global School Personnel Survey for 29 African countries (n = 17 929). Adjusted prevalence ratios (aPR) were calculated using multi-variable Poisson regression models to assess the impact of permissiveness toward tobacco sponsorship activities on support for tobacco control policies (p < 0.05). The median of prevalence of support for different tobacco control policies among all countries was as follows: complete ban on tobacco advertisements (84.9%); comprehensive smoke-free laws (92.4%) and tobacco price increases (80.8%). School personnel who believed that the tobacco industry should be allowed to sponsor school events were significantly less likely to support complete bans on tobacco advertisements [aPR = 0.89; 95% confidence interval (CI) 0.84–0.95] and comprehensive smoke-free laws (aPR = 0.95; 95% CI 0.92–0.98). In contrast, support for complete tobacco advertisement bans was more likely among those who believed that the tobacco industry encourages youths to smoke (aPR = 1.27; 95% CI 1.17–1.37), and among those who taught about health sometimes (aPR = 1.06; 95% CI 1.01–1.11) or a lot (aPR = 1.05; 95% CI 1.01–1.10) compared with those who did not teach about health at all. These findings underscore the need to educate school personnel on tobacco industry's strategies to undermine tobacco control policies. This may help to build school personnel support for laws intended to reduce youth susceptibility, experimentation and established use of tobacco products.
INTRODUCTION
Africa, with a relatively low prevalence of tobacco use in many of its countries, is considered by multinational tobacco companies as a new market (World Health Organization [WHO], 2013a,b). Corporate social investments (CSIs) are very important to the tobacco industry in new markets because they provide avenues for the tobacco industry to attempt to win the approval of society or policy makers by supporting indigenous activities such as agriculture (Jakpor, 2012). Despite the tobacco industry's claims that its involvement in CSI is ‘an end in itself, rather than as a means of promotion’ (British American Tobacco, 2012), the evidence shows that tobacco companies use such subterfuge marketing strategies to cast themselves in a positive light and increase societal acceptance while promoting their brand and corporate image (Ruel et al., 2004; Loomis et al., 2006, Otañez et al., 2006). During 2012, Philip Morris International and British-American-Tobacco Company spent a combined total of $57.5 million on CSIs globally, including in many low- and middle-income countries (British American Tobacco, 2012; Philip Morris International, 2012). Of the $38.2 million spent on CSIs by Philip Morris International alone in 2012, $23.3 million (70%) was spent in low- and middle-income countries (Philip Morris International, 2012).
Of particular concern is industry's targeting of youths using CSIs. For example, about a third of all Philip Morris International's CSIs in low- and middle-income countries in 2012 were targeted at school-going children—even those in Kindergarten (Philip Morris International, 2012). Some of these sponsorship activities included providing scholarships, vocational training, reconstructing/refurbishing schools and facilities for extra-curricular activities, provision of security for students and staff, as well as supply of stationeries and other infrastructure such as e-classrooms (Philip Morris International, 2012). Such indirect tobacco promotional activities coupled with other direct forms of tobacco marketing have been recognized as important catalysts that cause the initiation and progression of tobacco use among youths (U.S. Department of Health and Human Services [U.S. DHHS], 2012). Hence, the importance of complete bans on all direct and indirect forms of tobacco advertisements cannot be overemphasized. Article 13 of the WHO Framework Convention on Tobacco Control (FCTC) indicates that partial bans on tobacco advertisement and promotion may have only very limited effect in protecting youths from tobacco use, and hence recommends complete bans without any exemptions (WHO, 2013a,b). According to Article 13.1, Parties recognize that a comprehensive ban on advertising, promotion and sponsorship would reduce the consumption of tobacco products (WHO, 2013a,b). Currently, only 24 countries or 10% of the world's population have passed a complete ban on tobacco advertisement, promotion and sponsorships (WHO, 2013a,b). Low-income countries were reported to have been most likely not to have implemented any ban on tobacco advertisement (WHO, 2013a,b).
The objective of this study was to assess the impact of school personnel's permissiveness toward tobacco industry sponsorship activities on their support for comprehensive tobacco control efforts. We focused on school personnel considering that they exert significant influence on students, parents, and other members of the community and may influence policy adoption and support (Johnson et al., 2009). Data for the period 2006–2011 were obtained for 17 929 school personnel in 29 African countries using the Global School Personnel Survey database.
METHODS
Data source/sample
The Global School Personnel Survey is a school-based survey of school personnel selected from the sampling frame of schools that participated in the Global Youth Tobacco Surveys (GYTS). The GYTS was conducted among adolescent students aged 13–15 years using a two-stage cluster sample design to produce representative data for all surveyed sites.
The data analyses in this study involved all school personnel who participated in the Global School Personnel Surveys conducted during 2006–2011 in 29 African countries (total sample = 17 929). The sample sizes and survey years for the 29 sites are shown in Table 1. These sites were grouped into five sub-regions, following the United Nations geo-scheme as follows:
Southern Africa: Namibia, Swaziland, South Africa and Lesotho.
West Africa: Burkina Faso, Ghana, Mauritania, Niger, Senegal, Togo, Guinea Bissau and Sierra Leone.
Central Africa: Democratic Republic of the Congo (Kinshasa), Republic of the Congo, Central African Republic (Bangui) and Cameroon (Central District).
Eastern Africa: Djibouti, Somalia (Somaliland), Malawi, Uganda, Eritrea, Seychelles, Mauritius, Rwanda and Zimbabwe (Harare).
Northern Africa: Morocco, Tunisia, Libya and Sudan.
Region/site . | Survey year . | Class teachers (%) . | Females (%) . | Current any tobacco use % (95% CI) . |
---|---|---|---|---|
Southern Africa | ||||
Namibia (n = 746) | 2008 | 89.5 | 55.6 | 10.3 (6.5–14.1) |
Swaziland (n = 473) | 2009 | 95.2 | 58.4 | 7.8 (5.7–9.9) |
South Africa (n = 1,485) | 2011 | 94.2 | 62.7 | 7.8 (4.6–11) |
Lesotho (n = 103) | 2008 | 90.3 | 67.0 | 5.8 (n/a) |
Western Africa | ||||
Burkina Faso (n = 862) | 2009 | 90.3 | 29.9 | 8.8 (4.9–12.7) |
Ghana (n = 391) | 2009 | 85.1 | 32.5 | 5.2 (1.9–8.5) |
Mauritania (n = 505) | 2009 | 83.0 | 54.3 | 11.2 (7.2–15.3) |
Niger (n = 624) | 2009 | 92.7 | 77.3 | 11.3 (7.7–14.8) |
Senegal (n = 619) | 2007 | 93.9 | 19.6 | 15.9 (9.5–22.2) |
Togo (n = 488) | 2007 | 92.3 | 8.2 | 6.3 (2.5–10.2) |
Guinea Bissau (n = 555) | 2008 | 96.0 | 31.9 | 6.8 (6.8–6.8) |
Sierra Leone (n = 914) | 2008 | 93.5 | 75.7 | 9.8 (7.2–12.5) |
Central Africa | ||||
Democratic Republic of the Congo (Kinshasa) (n = 299) | 2008 | 85.5 | 82.2 | 27.0 (20.7–33.4) |
Republic of the Congo (n = 453) | 2009 | 82.3 | 24.1 | 22.1 (14.8–29.4) |
Central African Republic (Bangui) (n = 497) | 2008 | 87.2 | 21.6 | 30.2 (19.1–41.2) |
Cameroon (Central District) (n = 1712) | 2008 | 81.3 | 41.7 | 19.6 (16.6–22.7) |
Eastern Africa | ||||
Djibouti (n = 498) | 2009 | 77.5 | 75.4 | 41.6 (36.1–47.2) |
Somalia (Somaliland) (n = 214) | 2007 | 78.8 | 86.7 | 38.1 (25.3–51.0) |
Malawi (n = 276) | 2009 | 89.2 | 40.1 | 4.4 (1.1–7.6) |
Uganda (n = 682) | 2011 | 88.8 | 48.5 | 4.9 (2.0–7.8) |
Eritrea (n = 1,446) | 2006 | 91.7 | 36.4 | 9.6 (7.9–11.4) |
Seychelles (n = 516) | 2007 | 75.8 | 54.4 | 10.7 (8.1–13.4) |
Mauritius (n = 863) | 2008 | 97.2 | 55.6 | 11.1 (7.7–14.5) |
Rwanda (n = 200) | 2008 | 91.8 | 21.1 | 2.3 (0.2–4.3) |
Zimbabwe (Harare) (n = 233) | 2008 | 95.3 | 66.1 | 5.2 (n/a) |
Northern Africa | ||||
Morocco (n = 699) | 2010 | 77.1 | 66.5 | 21.5 (12.8–30.1) |
Tunisia (n = 66) | 2010 | 98.5 | 43.1 | 22.7 (n/a) |
Libya (n = 1,241) | 2010 | 76.8 | 36.7 | 20.3 (18.1–22.5) |
Sudan (n = 269) | 2009 | 86.9 | 57.3 | 8.5 (6.3–10.6) |
Region/site . | Survey year . | Class teachers (%) . | Females (%) . | Current any tobacco use % (95% CI) . |
---|---|---|---|---|
Southern Africa | ||||
Namibia (n = 746) | 2008 | 89.5 | 55.6 | 10.3 (6.5–14.1) |
Swaziland (n = 473) | 2009 | 95.2 | 58.4 | 7.8 (5.7–9.9) |
South Africa (n = 1,485) | 2011 | 94.2 | 62.7 | 7.8 (4.6–11) |
Lesotho (n = 103) | 2008 | 90.3 | 67.0 | 5.8 (n/a) |
Western Africa | ||||
Burkina Faso (n = 862) | 2009 | 90.3 | 29.9 | 8.8 (4.9–12.7) |
Ghana (n = 391) | 2009 | 85.1 | 32.5 | 5.2 (1.9–8.5) |
Mauritania (n = 505) | 2009 | 83.0 | 54.3 | 11.2 (7.2–15.3) |
Niger (n = 624) | 2009 | 92.7 | 77.3 | 11.3 (7.7–14.8) |
Senegal (n = 619) | 2007 | 93.9 | 19.6 | 15.9 (9.5–22.2) |
Togo (n = 488) | 2007 | 92.3 | 8.2 | 6.3 (2.5–10.2) |
Guinea Bissau (n = 555) | 2008 | 96.0 | 31.9 | 6.8 (6.8–6.8) |
Sierra Leone (n = 914) | 2008 | 93.5 | 75.7 | 9.8 (7.2–12.5) |
Central Africa | ||||
Democratic Republic of the Congo (Kinshasa) (n = 299) | 2008 | 85.5 | 82.2 | 27.0 (20.7–33.4) |
Republic of the Congo (n = 453) | 2009 | 82.3 | 24.1 | 22.1 (14.8–29.4) |
Central African Republic (Bangui) (n = 497) | 2008 | 87.2 | 21.6 | 30.2 (19.1–41.2) |
Cameroon (Central District) (n = 1712) | 2008 | 81.3 | 41.7 | 19.6 (16.6–22.7) |
Eastern Africa | ||||
Djibouti (n = 498) | 2009 | 77.5 | 75.4 | 41.6 (36.1–47.2) |
Somalia (Somaliland) (n = 214) | 2007 | 78.8 | 86.7 | 38.1 (25.3–51.0) |
Malawi (n = 276) | 2009 | 89.2 | 40.1 | 4.4 (1.1–7.6) |
Uganda (n = 682) | 2011 | 88.8 | 48.5 | 4.9 (2.0–7.8) |
Eritrea (n = 1,446) | 2006 | 91.7 | 36.4 | 9.6 (7.9–11.4) |
Seychelles (n = 516) | 2007 | 75.8 | 54.4 | 10.7 (8.1–13.4) |
Mauritius (n = 863) | 2008 | 97.2 | 55.6 | 11.1 (7.7–14.5) |
Rwanda (n = 200) | 2008 | 91.8 | 21.1 | 2.3 (0.2–4.3) |
Zimbabwe (Harare) (n = 233) | 2008 | 95.3 | 66.1 | 5.2 (n/a) |
Northern Africa | ||||
Morocco (n = 699) | 2010 | 77.1 | 66.5 | 21.5 (12.8–30.1) |
Tunisia (n = 66) | 2010 | 98.5 | 43.1 | 22.7 (n/a) |
Libya (n = 1,241) | 2010 | 76.8 | 36.7 | 20.3 (18.1–22.5) |
Sudan (n = 269) | 2009 | 86.9 | 57.3 | 8.5 (6.3–10.6) |
CI, confidence interval; n/a, not applicable (both upper and lower confidence limits identical to point estimate since a complete census of school personnel was taken, yielding final survey sampling weight = 1 for all respondents).
Region/site . | Survey year . | Class teachers (%) . | Females (%) . | Current any tobacco use % (95% CI) . |
---|---|---|---|---|
Southern Africa | ||||
Namibia (n = 746) | 2008 | 89.5 | 55.6 | 10.3 (6.5–14.1) |
Swaziland (n = 473) | 2009 | 95.2 | 58.4 | 7.8 (5.7–9.9) |
South Africa (n = 1,485) | 2011 | 94.2 | 62.7 | 7.8 (4.6–11) |
Lesotho (n = 103) | 2008 | 90.3 | 67.0 | 5.8 (n/a) |
Western Africa | ||||
Burkina Faso (n = 862) | 2009 | 90.3 | 29.9 | 8.8 (4.9–12.7) |
Ghana (n = 391) | 2009 | 85.1 | 32.5 | 5.2 (1.9–8.5) |
Mauritania (n = 505) | 2009 | 83.0 | 54.3 | 11.2 (7.2–15.3) |
Niger (n = 624) | 2009 | 92.7 | 77.3 | 11.3 (7.7–14.8) |
Senegal (n = 619) | 2007 | 93.9 | 19.6 | 15.9 (9.5–22.2) |
Togo (n = 488) | 2007 | 92.3 | 8.2 | 6.3 (2.5–10.2) |
Guinea Bissau (n = 555) | 2008 | 96.0 | 31.9 | 6.8 (6.8–6.8) |
Sierra Leone (n = 914) | 2008 | 93.5 | 75.7 | 9.8 (7.2–12.5) |
Central Africa | ||||
Democratic Republic of the Congo (Kinshasa) (n = 299) | 2008 | 85.5 | 82.2 | 27.0 (20.7–33.4) |
Republic of the Congo (n = 453) | 2009 | 82.3 | 24.1 | 22.1 (14.8–29.4) |
Central African Republic (Bangui) (n = 497) | 2008 | 87.2 | 21.6 | 30.2 (19.1–41.2) |
Cameroon (Central District) (n = 1712) | 2008 | 81.3 | 41.7 | 19.6 (16.6–22.7) |
Eastern Africa | ||||
Djibouti (n = 498) | 2009 | 77.5 | 75.4 | 41.6 (36.1–47.2) |
Somalia (Somaliland) (n = 214) | 2007 | 78.8 | 86.7 | 38.1 (25.3–51.0) |
Malawi (n = 276) | 2009 | 89.2 | 40.1 | 4.4 (1.1–7.6) |
Uganda (n = 682) | 2011 | 88.8 | 48.5 | 4.9 (2.0–7.8) |
Eritrea (n = 1,446) | 2006 | 91.7 | 36.4 | 9.6 (7.9–11.4) |
Seychelles (n = 516) | 2007 | 75.8 | 54.4 | 10.7 (8.1–13.4) |
Mauritius (n = 863) | 2008 | 97.2 | 55.6 | 11.1 (7.7–14.5) |
Rwanda (n = 200) | 2008 | 91.8 | 21.1 | 2.3 (0.2–4.3) |
Zimbabwe (Harare) (n = 233) | 2008 | 95.3 | 66.1 | 5.2 (n/a) |
Northern Africa | ||||
Morocco (n = 699) | 2010 | 77.1 | 66.5 | 21.5 (12.8–30.1) |
Tunisia (n = 66) | 2010 | 98.5 | 43.1 | 22.7 (n/a) |
Libya (n = 1,241) | 2010 | 76.8 | 36.7 | 20.3 (18.1–22.5) |
Sudan (n = 269) | 2009 | 86.9 | 57.3 | 8.5 (6.3–10.6) |
Region/site . | Survey year . | Class teachers (%) . | Females (%) . | Current any tobacco use % (95% CI) . |
---|---|---|---|---|
Southern Africa | ||||
Namibia (n = 746) | 2008 | 89.5 | 55.6 | 10.3 (6.5–14.1) |
Swaziland (n = 473) | 2009 | 95.2 | 58.4 | 7.8 (5.7–9.9) |
South Africa (n = 1,485) | 2011 | 94.2 | 62.7 | 7.8 (4.6–11) |
Lesotho (n = 103) | 2008 | 90.3 | 67.0 | 5.8 (n/a) |
Western Africa | ||||
Burkina Faso (n = 862) | 2009 | 90.3 | 29.9 | 8.8 (4.9–12.7) |
Ghana (n = 391) | 2009 | 85.1 | 32.5 | 5.2 (1.9–8.5) |
Mauritania (n = 505) | 2009 | 83.0 | 54.3 | 11.2 (7.2–15.3) |
Niger (n = 624) | 2009 | 92.7 | 77.3 | 11.3 (7.7–14.8) |
Senegal (n = 619) | 2007 | 93.9 | 19.6 | 15.9 (9.5–22.2) |
Togo (n = 488) | 2007 | 92.3 | 8.2 | 6.3 (2.5–10.2) |
Guinea Bissau (n = 555) | 2008 | 96.0 | 31.9 | 6.8 (6.8–6.8) |
Sierra Leone (n = 914) | 2008 | 93.5 | 75.7 | 9.8 (7.2–12.5) |
Central Africa | ||||
Democratic Republic of the Congo (Kinshasa) (n = 299) | 2008 | 85.5 | 82.2 | 27.0 (20.7–33.4) |
Republic of the Congo (n = 453) | 2009 | 82.3 | 24.1 | 22.1 (14.8–29.4) |
Central African Republic (Bangui) (n = 497) | 2008 | 87.2 | 21.6 | 30.2 (19.1–41.2) |
Cameroon (Central District) (n = 1712) | 2008 | 81.3 | 41.7 | 19.6 (16.6–22.7) |
Eastern Africa | ||||
Djibouti (n = 498) | 2009 | 77.5 | 75.4 | 41.6 (36.1–47.2) |
Somalia (Somaliland) (n = 214) | 2007 | 78.8 | 86.7 | 38.1 (25.3–51.0) |
Malawi (n = 276) | 2009 | 89.2 | 40.1 | 4.4 (1.1–7.6) |
Uganda (n = 682) | 2011 | 88.8 | 48.5 | 4.9 (2.0–7.8) |
Eritrea (n = 1,446) | 2006 | 91.7 | 36.4 | 9.6 (7.9–11.4) |
Seychelles (n = 516) | 2007 | 75.8 | 54.4 | 10.7 (8.1–13.4) |
Mauritius (n = 863) | 2008 | 97.2 | 55.6 | 11.1 (7.7–14.5) |
Rwanda (n = 200) | 2008 | 91.8 | 21.1 | 2.3 (0.2–4.3) |
Zimbabwe (Harare) (n = 233) | 2008 | 95.3 | 66.1 | 5.2 (n/a) |
Northern Africa | ||||
Morocco (n = 699) | 2010 | 77.1 | 66.5 | 21.5 (12.8–30.1) |
Tunisia (n = 66) | 2010 | 98.5 | 43.1 | 22.7 (n/a) |
Libya (n = 1,241) | 2010 | 76.8 | 36.7 | 20.3 (18.1–22.5) |
Sudan (n = 269) | 2009 | 86.9 | 57.3 | 8.5 (6.3–10.6) |
CI, confidence interval; n/a, not applicable (both upper and lower confidence limits identical to point estimate since a complete census of school personnel was taken, yielding final survey sampling weight = 1 for all respondents).
Measures
The Global School Personnel Survey used a self-administered questionnaire to obtain information from study participants. Socio-demographic characteristics assessed included age (<30; 30–39; 40–49 or ≥50 years), sex (male or female), type of school personnel (teacher or administrative staff such as school principal or nurse), extent involved in teaching about health as a proxy for degree of health literacy (not at all involved; not a primary duty but teach sometimes or primary duty and teach all the time) and survey year (2006–2011).
Tobacco use and perceptions
Current any tobacco users were defined as respondents who reported smoking cigarettes, cigars, pipes, bidis, kreteks, water pipes, chewing tobacco or snuff ‘daily’ or ‘occasionally’.
School personnel's perception about the effect of teachers' tobacco use on youth tobacco initiation was assessed with the question ‘Do you think teacher tobacco use influences youth tobacco use?’ Categorical responses were ‘Yes' or ‘No’.
Perception about tobacco industry sponsorship activities and targeting of youths
Perception about whether tobacco companies should be allowed to sponsor school events was assessed with the question ‘Do you think the tobacco industry should be allowed to sponsor school or extra-curricular activities, such as sporting events?’ Categorical responses were ‘Yes’ or ‘No’.
Perception that tobacco companies try to encourage tobacco use among youths was defined as a ‘Yes’ response to the question ‘Do you think the tobacco industry deliberately encourages youth to use tobacco?’
Support for tobacco control policies
We measured school personnel's attitude toward three tobacco control policies related to the WHO MPOWER package, namely: complete bans on tobacco advertisement, promotion and sponsorships; increased price of tobacco products; and comprehensive smoke-free laws in public places. These were assessed with the following questions, each with a categorical response option of ‘Yes’ or ‘No’. (1) ‘Do you think tobacco product advertising should be completely banned?’ (2) ‘Do you think the price of tobacco products should be increased?’ (3) ‘Do you think cigarette smoking should be banned in public places?’
Data analysis
Data were analyzed using STATA 12 (Stata Corporation, College Station, TX, USA), with appropriate weighting of selection probabilities. Group differences were assessed using χ2 statistics. The outcomes of interest were support for complete ban on all tobacco advertisements; increased price on tobacco products and comprehensive smoke-free policies in all public places. Adjusted prevalence ratios (aPR) were calculated for the respective outcomes in separate multi-variate Poisson regression models. Poisson rather than logistic regression was used because the outcomes of interest were common, and also because prevalence ratios allow for ease of interpretation and communication (Barros and Hirakata, 2003). Independent variables were included in the final models based on both their significance on bivariate analyses at the 5% alpha level, as well as their importance as potential determinants of the relationship between permissiveness toward tobacco industry sponsorship activities and support for tobacco control policies (WHO, 2013a,b).
The final models included the following independent variables: perception about whether the tobacco industry should be allowed to sponsor school events; perception regarding the influence of teachers' tobacco use on youths' tobacco initiation, perception about tobacco industry targeting of youths with tobacco products; extent involved in teaching about health, region, survey year, age, sex, type of school personnel and cigarette smoking status. Statistical significance in the final analyses was set at p < 0.05.
RESULTS
The proportion of female school personnel ranged from 8.2% (Togo) to 86.7% (Somaliland, Somalia). Overall prevalence of any tobacco use ranged from 2.3% (Rwanda) to 38.1% (Somaliland, Somalia). Other characteristics of the study participants are shown in Table 1.
Support for complete bans on tobacco advertisements
Prevalence of support for complete bans on tobacco advertisements ranged from 65.3% in Malawi, to 94.4% in Mauritania, with a median support of 84.9% (Table 2).
Region/site . | Support for complete ban on all tobacco advertisements, % (95% CI) . | Support for increased price on tobacco products, % (95% CI) . | Support for comprehensive smoke-free policies in public places, % (95% CI) . |
---|---|---|---|
Southern Africa | |||
Namibia (n = 746) | 80.5 (76.9–84.1) | 79.3 (75.8–82.9) | 79.7 (76.6–82.9) |
Swaziland (n = 473) | 82.5 (77.7–87.2) | 85.0 (80.9–89.2) | 93.7 (90.8–96.7) |
South Africa (n = 1,485) | 74.7 (64.4–84.9) | 81.1 (76.7–85.4) | 90.8 (84.6–96.9) |
Lesotho (n = 103) | 89.2 (n/a) | 81.2 (n/a) | 75.7 (n/a) |
West Africa | |||
Burkina Faso (n = 862) | 92.5 (89.1–96.0) | 84.1 (77.9–90.3) | 94.8 (91.6–97.9) |
Ghana (n = 391) | 88.9 (85.3–92.4) | 81.7 (75.9–87.5) | 95.5 (92.6–98.4) |
Mauritania (n = 505) | 94.2 (92.5–95.9) | 93.3 (90.6–96.0) | 96.9 (94.3–99.5) |
Niger (n = 624) | 86.2 (83.2–89.2) | 86.1 (81.8–90.5) | 95.6 (92.2–99.1) |
Senegal (n = 619) | 90.3 (86.6–94.0) | 84.5 (80.0–89.1) | 90.7 (87.1–94.4) |
Togo (n = 488) | 91.7 (88.4–95.0) | 90.5 (86.1–94.9) | 95.2 (93.1–97.3) |
Guinea Bissau (n = 555) | 86.8 (86.8–86.8) | 89.5 (89.5–89.5) | 94.6 (94.6–94.6) |
Sierra Leone (n = 914) | 83.8 (80.1–87.5) | 83.9 (80.7–87.1) | 94.2 (92.7–95.7) |
Central Africa | |||
Democratic Republic of the Congo (Kinshasa) (n = 299) | 87.9 (82.7–93.2) | 76.4 (67.5–85.4) | 91.6 (84.5–98.6) |
Republic of the Congo (n = 453) | 83.4 (76.7–90.1) | 79.1 (73.9–84.4) | 92.3 (89.5–95.2) |
Central African Republic (Bangui) (n = 497) | 72.0 (66.1–77.9) | 81.5 (77.5–85.5) | 91.3 (88.2–94.3) |
Cameroon (Central District) (n = 1712) | 80.3 (77.7–82.9) | –a | 92.9 (89.3–96.4) |
Eastern Africa | |||
Djibouti (n = 498) | 85.9 (81.6–90.2) | 85.0 (81.2–88.7) | 85.5 (80.3–90.7) |
Somalia (Somaliland) (n = 214) | 59.3 (48.3–70.2) | 67.7 (54.1–81.3) | 66.0 (50.9–81.2) |
Malawi (n = 276) | 65.3 (59.7–71.0) | 78.6 (70.5–86.7) | 88.4 (79.0–97.9) |
Uganda (n = 682) | 75.4 (68.5–82.3) | 78.3 (71.6–85.1) | 92.7 (89.4–96.0) |
Eritrea (n = 1,446) | 73.0 (68.9–77.0) | 65.6 (59.6–71.6) | 70.7 (60.6–80.9) |
Seychelles (n = 516) | 73.5 (70.2–76.7) | 64.7 (61.2–68.2) | 88.6 (85.8–91.3) |
Mauritius (n = 863) | 84.9 (81.8–87.9) | 81.5 (78.1–84.9) | 93.5 (90.1–96.8) |
Rwanda (n = 200) | 76.6 (71.5–81.6) | 73.0 (63.2–82.8) | 94.7 (90.5–99.0) |
Zimbabwe (Harare) (n = 233) | 45.6 (n/a) | 80.2 (n/a) | 85.8 (n/a) |
Northern Africa | |||
Morocco (n = 699) | 91.3 (88.6–94.0) | 79.5 (73.0–86.0) | 93.0 (90.3–95.6) |
Tunisia (n = 66) | 92.4 (n/a) | 78.8 (n/a) | 97.0 (n/a) |
Libya (n = 1,241) | 87.8 (81.9–93.8) | 70.0 (57.8–82.2) | 89.8 (87.3–92.3) |
Sudan (n = 269) | 93.3 (89.4–97.1) | 80.5 (74.3–86.6) | 92.4 (88.1–96.7) |
Region/site . | Support for complete ban on all tobacco advertisements, % (95% CI) . | Support for increased price on tobacco products, % (95% CI) . | Support for comprehensive smoke-free policies in public places, % (95% CI) . |
---|---|---|---|
Southern Africa | |||
Namibia (n = 746) | 80.5 (76.9–84.1) | 79.3 (75.8–82.9) | 79.7 (76.6–82.9) |
Swaziland (n = 473) | 82.5 (77.7–87.2) | 85.0 (80.9–89.2) | 93.7 (90.8–96.7) |
South Africa (n = 1,485) | 74.7 (64.4–84.9) | 81.1 (76.7–85.4) | 90.8 (84.6–96.9) |
Lesotho (n = 103) | 89.2 (n/a) | 81.2 (n/a) | 75.7 (n/a) |
West Africa | |||
Burkina Faso (n = 862) | 92.5 (89.1–96.0) | 84.1 (77.9–90.3) | 94.8 (91.6–97.9) |
Ghana (n = 391) | 88.9 (85.3–92.4) | 81.7 (75.9–87.5) | 95.5 (92.6–98.4) |
Mauritania (n = 505) | 94.2 (92.5–95.9) | 93.3 (90.6–96.0) | 96.9 (94.3–99.5) |
Niger (n = 624) | 86.2 (83.2–89.2) | 86.1 (81.8–90.5) | 95.6 (92.2–99.1) |
Senegal (n = 619) | 90.3 (86.6–94.0) | 84.5 (80.0–89.1) | 90.7 (87.1–94.4) |
Togo (n = 488) | 91.7 (88.4–95.0) | 90.5 (86.1–94.9) | 95.2 (93.1–97.3) |
Guinea Bissau (n = 555) | 86.8 (86.8–86.8) | 89.5 (89.5–89.5) | 94.6 (94.6–94.6) |
Sierra Leone (n = 914) | 83.8 (80.1–87.5) | 83.9 (80.7–87.1) | 94.2 (92.7–95.7) |
Central Africa | |||
Democratic Republic of the Congo (Kinshasa) (n = 299) | 87.9 (82.7–93.2) | 76.4 (67.5–85.4) | 91.6 (84.5–98.6) |
Republic of the Congo (n = 453) | 83.4 (76.7–90.1) | 79.1 (73.9–84.4) | 92.3 (89.5–95.2) |
Central African Republic (Bangui) (n = 497) | 72.0 (66.1–77.9) | 81.5 (77.5–85.5) | 91.3 (88.2–94.3) |
Cameroon (Central District) (n = 1712) | 80.3 (77.7–82.9) | –a | 92.9 (89.3–96.4) |
Eastern Africa | |||
Djibouti (n = 498) | 85.9 (81.6–90.2) | 85.0 (81.2–88.7) | 85.5 (80.3–90.7) |
Somalia (Somaliland) (n = 214) | 59.3 (48.3–70.2) | 67.7 (54.1–81.3) | 66.0 (50.9–81.2) |
Malawi (n = 276) | 65.3 (59.7–71.0) | 78.6 (70.5–86.7) | 88.4 (79.0–97.9) |
Uganda (n = 682) | 75.4 (68.5–82.3) | 78.3 (71.6–85.1) | 92.7 (89.4–96.0) |
Eritrea (n = 1,446) | 73.0 (68.9–77.0) | 65.6 (59.6–71.6) | 70.7 (60.6–80.9) |
Seychelles (n = 516) | 73.5 (70.2–76.7) | 64.7 (61.2–68.2) | 88.6 (85.8–91.3) |
Mauritius (n = 863) | 84.9 (81.8–87.9) | 81.5 (78.1–84.9) | 93.5 (90.1–96.8) |
Rwanda (n = 200) | 76.6 (71.5–81.6) | 73.0 (63.2–82.8) | 94.7 (90.5–99.0) |
Zimbabwe (Harare) (n = 233) | 45.6 (n/a) | 80.2 (n/a) | 85.8 (n/a) |
Northern Africa | |||
Morocco (n = 699) | 91.3 (88.6–94.0) | 79.5 (73.0–86.0) | 93.0 (90.3–95.6) |
Tunisia (n = 66) | 92.4 (n/a) | 78.8 (n/a) | 97.0 (n/a) |
Libya (n = 1,241) | 87.8 (81.9–93.8) | 70.0 (57.8–82.2) | 89.8 (87.3–92.3) |
Sudan (n = 269) | 93.3 (89.4–97.1) | 80.5 (74.3–86.6) | 92.4 (88.1–96.7) |
CI, confidence interval; n/a, not applicable (both upper and lower confidence limits identical to point estimate since a complete census of school personnel was taken, yielding final survey sampling weight = 1 for all respondents).
aData not available (question not asked).
Region/site . | Support for complete ban on all tobacco advertisements, % (95% CI) . | Support for increased price on tobacco products, % (95% CI) . | Support for comprehensive smoke-free policies in public places, % (95% CI) . |
---|---|---|---|
Southern Africa | |||
Namibia (n = 746) | 80.5 (76.9–84.1) | 79.3 (75.8–82.9) | 79.7 (76.6–82.9) |
Swaziland (n = 473) | 82.5 (77.7–87.2) | 85.0 (80.9–89.2) | 93.7 (90.8–96.7) |
South Africa (n = 1,485) | 74.7 (64.4–84.9) | 81.1 (76.7–85.4) | 90.8 (84.6–96.9) |
Lesotho (n = 103) | 89.2 (n/a) | 81.2 (n/a) | 75.7 (n/a) |
West Africa | |||
Burkina Faso (n = 862) | 92.5 (89.1–96.0) | 84.1 (77.9–90.3) | 94.8 (91.6–97.9) |
Ghana (n = 391) | 88.9 (85.3–92.4) | 81.7 (75.9–87.5) | 95.5 (92.6–98.4) |
Mauritania (n = 505) | 94.2 (92.5–95.9) | 93.3 (90.6–96.0) | 96.9 (94.3–99.5) |
Niger (n = 624) | 86.2 (83.2–89.2) | 86.1 (81.8–90.5) | 95.6 (92.2–99.1) |
Senegal (n = 619) | 90.3 (86.6–94.0) | 84.5 (80.0–89.1) | 90.7 (87.1–94.4) |
Togo (n = 488) | 91.7 (88.4–95.0) | 90.5 (86.1–94.9) | 95.2 (93.1–97.3) |
Guinea Bissau (n = 555) | 86.8 (86.8–86.8) | 89.5 (89.5–89.5) | 94.6 (94.6–94.6) |
Sierra Leone (n = 914) | 83.8 (80.1–87.5) | 83.9 (80.7–87.1) | 94.2 (92.7–95.7) |
Central Africa | |||
Democratic Republic of the Congo (Kinshasa) (n = 299) | 87.9 (82.7–93.2) | 76.4 (67.5–85.4) | 91.6 (84.5–98.6) |
Republic of the Congo (n = 453) | 83.4 (76.7–90.1) | 79.1 (73.9–84.4) | 92.3 (89.5–95.2) |
Central African Republic (Bangui) (n = 497) | 72.0 (66.1–77.9) | 81.5 (77.5–85.5) | 91.3 (88.2–94.3) |
Cameroon (Central District) (n = 1712) | 80.3 (77.7–82.9) | –a | 92.9 (89.3–96.4) |
Eastern Africa | |||
Djibouti (n = 498) | 85.9 (81.6–90.2) | 85.0 (81.2–88.7) | 85.5 (80.3–90.7) |
Somalia (Somaliland) (n = 214) | 59.3 (48.3–70.2) | 67.7 (54.1–81.3) | 66.0 (50.9–81.2) |
Malawi (n = 276) | 65.3 (59.7–71.0) | 78.6 (70.5–86.7) | 88.4 (79.0–97.9) |
Uganda (n = 682) | 75.4 (68.5–82.3) | 78.3 (71.6–85.1) | 92.7 (89.4–96.0) |
Eritrea (n = 1,446) | 73.0 (68.9–77.0) | 65.6 (59.6–71.6) | 70.7 (60.6–80.9) |
Seychelles (n = 516) | 73.5 (70.2–76.7) | 64.7 (61.2–68.2) | 88.6 (85.8–91.3) |
Mauritius (n = 863) | 84.9 (81.8–87.9) | 81.5 (78.1–84.9) | 93.5 (90.1–96.8) |
Rwanda (n = 200) | 76.6 (71.5–81.6) | 73.0 (63.2–82.8) | 94.7 (90.5–99.0) |
Zimbabwe (Harare) (n = 233) | 45.6 (n/a) | 80.2 (n/a) | 85.8 (n/a) |
Northern Africa | |||
Morocco (n = 699) | 91.3 (88.6–94.0) | 79.5 (73.0–86.0) | 93.0 (90.3–95.6) |
Tunisia (n = 66) | 92.4 (n/a) | 78.8 (n/a) | 97.0 (n/a) |
Libya (n = 1,241) | 87.8 (81.9–93.8) | 70.0 (57.8–82.2) | 89.8 (87.3–92.3) |
Sudan (n = 269) | 93.3 (89.4–97.1) | 80.5 (74.3–86.6) | 92.4 (88.1–96.7) |
Region/site . | Support for complete ban on all tobacco advertisements, % (95% CI) . | Support for increased price on tobacco products, % (95% CI) . | Support for comprehensive smoke-free policies in public places, % (95% CI) . |
---|---|---|---|
Southern Africa | |||
Namibia (n = 746) | 80.5 (76.9–84.1) | 79.3 (75.8–82.9) | 79.7 (76.6–82.9) |
Swaziland (n = 473) | 82.5 (77.7–87.2) | 85.0 (80.9–89.2) | 93.7 (90.8–96.7) |
South Africa (n = 1,485) | 74.7 (64.4–84.9) | 81.1 (76.7–85.4) | 90.8 (84.6–96.9) |
Lesotho (n = 103) | 89.2 (n/a) | 81.2 (n/a) | 75.7 (n/a) |
West Africa | |||
Burkina Faso (n = 862) | 92.5 (89.1–96.0) | 84.1 (77.9–90.3) | 94.8 (91.6–97.9) |
Ghana (n = 391) | 88.9 (85.3–92.4) | 81.7 (75.9–87.5) | 95.5 (92.6–98.4) |
Mauritania (n = 505) | 94.2 (92.5–95.9) | 93.3 (90.6–96.0) | 96.9 (94.3–99.5) |
Niger (n = 624) | 86.2 (83.2–89.2) | 86.1 (81.8–90.5) | 95.6 (92.2–99.1) |
Senegal (n = 619) | 90.3 (86.6–94.0) | 84.5 (80.0–89.1) | 90.7 (87.1–94.4) |
Togo (n = 488) | 91.7 (88.4–95.0) | 90.5 (86.1–94.9) | 95.2 (93.1–97.3) |
Guinea Bissau (n = 555) | 86.8 (86.8–86.8) | 89.5 (89.5–89.5) | 94.6 (94.6–94.6) |
Sierra Leone (n = 914) | 83.8 (80.1–87.5) | 83.9 (80.7–87.1) | 94.2 (92.7–95.7) |
Central Africa | |||
Democratic Republic of the Congo (Kinshasa) (n = 299) | 87.9 (82.7–93.2) | 76.4 (67.5–85.4) | 91.6 (84.5–98.6) |
Republic of the Congo (n = 453) | 83.4 (76.7–90.1) | 79.1 (73.9–84.4) | 92.3 (89.5–95.2) |
Central African Republic (Bangui) (n = 497) | 72.0 (66.1–77.9) | 81.5 (77.5–85.5) | 91.3 (88.2–94.3) |
Cameroon (Central District) (n = 1712) | 80.3 (77.7–82.9) | –a | 92.9 (89.3–96.4) |
Eastern Africa | |||
Djibouti (n = 498) | 85.9 (81.6–90.2) | 85.0 (81.2–88.7) | 85.5 (80.3–90.7) |
Somalia (Somaliland) (n = 214) | 59.3 (48.3–70.2) | 67.7 (54.1–81.3) | 66.0 (50.9–81.2) |
Malawi (n = 276) | 65.3 (59.7–71.0) | 78.6 (70.5–86.7) | 88.4 (79.0–97.9) |
Uganda (n = 682) | 75.4 (68.5–82.3) | 78.3 (71.6–85.1) | 92.7 (89.4–96.0) |
Eritrea (n = 1,446) | 73.0 (68.9–77.0) | 65.6 (59.6–71.6) | 70.7 (60.6–80.9) |
Seychelles (n = 516) | 73.5 (70.2–76.7) | 64.7 (61.2–68.2) | 88.6 (85.8–91.3) |
Mauritius (n = 863) | 84.9 (81.8–87.9) | 81.5 (78.1–84.9) | 93.5 (90.1–96.8) |
Rwanda (n = 200) | 76.6 (71.5–81.6) | 73.0 (63.2–82.8) | 94.7 (90.5–99.0) |
Zimbabwe (Harare) (n = 233) | 45.6 (n/a) | 80.2 (n/a) | 85.8 (n/a) |
Northern Africa | |||
Morocco (n = 699) | 91.3 (88.6–94.0) | 79.5 (73.0–86.0) | 93.0 (90.3–95.6) |
Tunisia (n = 66) | 92.4 (n/a) | 78.8 (n/a) | 97.0 (n/a) |
Libya (n = 1,241) | 87.8 (81.9–93.8) | 70.0 (57.8–82.2) | 89.8 (87.3–92.3) |
Sudan (n = 269) | 93.3 (89.4–97.1) | 80.5 (74.3–86.6) | 92.4 (88.1–96.7) |
CI, confidence interval; n/a, not applicable (both upper and lower confidence limits identical to point estimate since a complete census of school personnel was taken, yielding final survey sampling weight = 1 for all respondents).
aData not available (question not asked).
The likelihood of support for complete bans on tobacco advertisements was lower among school personnel who believed that the tobacco industry should be allowed to sponsor school events (aPR = 0.89; 95% CI 0.84–0.95) (Table 3). Conversely, the likelihood was higher among school personnel who believed that the tobacco industry encourages youth to smoke (aPR = 1.27; 95% CI 1.17–1.37), as well as among those who taught about health sometimes (aPR = 1.06; 95% CI 1.01–1.11) or a lot (aPR = 1.05; 95% CI 1.01–1.10) compared with those who did not teach about health at all. By region, the likelihood of supporting complete bans on tobacco advertisements was higher among school personnel in West Africa (aPR = 1.16; 95% CI: 1.05–1.28) and Northern Africa (aPR = 1.17; 95% CI 1.05–1.30) compared with those in Southern Africa. No difference in support for complete bans on tobacco advertisements was observed by other characteristics assessed.
Characteristic . | Category . | Support for complete ban on all tobacco advertisements aPR (95% CI) . | Support for increased price on tobacco products aPR (95% CI) . | Support for comprehensive smoke-free policies in public places aPR (95% CI) . |
---|---|---|---|---|
Perception that the tobacco industry should be allowed to sponsor school events | No (referent) | |||
Yes | 0.89 (0.84–0.95)a | 1.02 (0.95–1.10) | 0.95 (0.92–0.98)a | |
Belief that the tobacco industry encourages youths to use tobacco products | No (referent) | |||
Yes | 1.27 (1.17–1.37)a | 1.13 (0.99–1.28) | 1.02 (0.98–1.05) | |
Perception that teachers' tobacco use influences youths to use tobacco products | No (referent) | |||
Yes | 1.01 (0.90–1.14) | 1.14 (0.86–1.50) | 1.13 (1.03–1.24)a | |
Extent involved in teaching about health | Not at all (referent) | |||
Not primary duty, teach sometimes | 1.06 (1.01–1.11)a | 1.12 (1.02–1.24)a | 1.02 (0.99–1.06) | |
Primary duty, teach a lot | 1.05 (1.01–1.10)a | 1.09 (0.99–1.19) | 1.02 (0.98–1.06) | |
Current smoking status | Nonsmoker (referent) | |||
Smoker | 1.05 (0.96–1.14) | 0.74 (0.62–0.88)a | 0.98 (0.91–1.05) | |
Type of school personnel | Teacher (referent) | |||
Administrative | 1.02 (0.97–1.08) | 0.95 (0.86–1.04) | 1.04 (1.01–1.08)a | |
Region | Southern Africa (referent) | |||
West Africa | 1.16 (1.05–1.28)a | 0.97 (0.87–1.07) | 1.03 (0.97–1.09) | |
Central Africa | 1.05 (0.94–1.17) | 0.90 (0.82–0.99) | 1.00 (0.95–1.06) | |
Eastern African | 0.95 (0.86–1.05) | 0.93 (0.87–1.00) | 0.99 (0.93–1.06) | |
Northern Africa | 1.17 (1.05–1.30)a | 0.91 (0.81–1.03) | 1.00 (0.93–1.07) | |
Year | 2006 (referent) | |||
2007 | 0.93 (0.84–1.02) | 1.17 (1.03–1.34)a | 1.21 (1.02–1.44)a | |
2008 | 0.95 (0.88–1.03) | 1.14 (1.02–1.28)a | 1.26 (1.07–1.48)a | |
2009 | 0.94 (0.86–1.04) | 1.15 (1.02–1.31)a | 1.26 (1.05–1.50)a | |
2010 | 0.97 (0.87–1.08) | 1.16 (0.98–1.38) | 1.27 (1.06–1.53)a | |
2011 | 0.98 (0.88–1.08) | 1.15 (1.02–1.29)a | 1.28 (1.09–1.50)a | |
Age, years | <30 (referent) | |||
30–39 | 1.03 (0.97–1.08) | 1.01 (0.92–1.11) | 1.02 (0.98–1.06) | |
40–49 | 1.01 (0.93–1.08) | 1.05 (0.96–1.14) | 1.02 (0.97–1.07) | |
≥50 | 1.02 (0.94–1.10) | 1.08 (0.98–1.19) | 1.05 (1.00–1.10) | |
Sex | Male (referent) | |||
Female | 1.03 (0.99–1.08) | 0.95 (0.91–0.99)a | 0.99 (0.96–1.02) |
Characteristic . | Category . | Support for complete ban on all tobacco advertisements aPR (95% CI) . | Support for increased price on tobacco products aPR (95% CI) . | Support for comprehensive smoke-free policies in public places aPR (95% CI) . |
---|---|---|---|---|
Perception that the tobacco industry should be allowed to sponsor school events | No (referent) | |||
Yes | 0.89 (0.84–0.95)a | 1.02 (0.95–1.10) | 0.95 (0.92–0.98)a | |
Belief that the tobacco industry encourages youths to use tobacco products | No (referent) | |||
Yes | 1.27 (1.17–1.37)a | 1.13 (0.99–1.28) | 1.02 (0.98–1.05) | |
Perception that teachers' tobacco use influences youths to use tobacco products | No (referent) | |||
Yes | 1.01 (0.90–1.14) | 1.14 (0.86–1.50) | 1.13 (1.03–1.24)a | |
Extent involved in teaching about health | Not at all (referent) | |||
Not primary duty, teach sometimes | 1.06 (1.01–1.11)a | 1.12 (1.02–1.24)a | 1.02 (0.99–1.06) | |
Primary duty, teach a lot | 1.05 (1.01–1.10)a | 1.09 (0.99–1.19) | 1.02 (0.98–1.06) | |
Current smoking status | Nonsmoker (referent) | |||
Smoker | 1.05 (0.96–1.14) | 0.74 (0.62–0.88)a | 0.98 (0.91–1.05) | |
Type of school personnel | Teacher (referent) | |||
Administrative | 1.02 (0.97–1.08) | 0.95 (0.86–1.04) | 1.04 (1.01–1.08)a | |
Region | Southern Africa (referent) | |||
West Africa | 1.16 (1.05–1.28)a | 0.97 (0.87–1.07) | 1.03 (0.97–1.09) | |
Central Africa | 1.05 (0.94–1.17) | 0.90 (0.82–0.99) | 1.00 (0.95–1.06) | |
Eastern African | 0.95 (0.86–1.05) | 0.93 (0.87–1.00) | 0.99 (0.93–1.06) | |
Northern Africa | 1.17 (1.05–1.30)a | 0.91 (0.81–1.03) | 1.00 (0.93–1.07) | |
Year | 2006 (referent) | |||
2007 | 0.93 (0.84–1.02) | 1.17 (1.03–1.34)a | 1.21 (1.02–1.44)a | |
2008 | 0.95 (0.88–1.03) | 1.14 (1.02–1.28)a | 1.26 (1.07–1.48)a | |
2009 | 0.94 (0.86–1.04) | 1.15 (1.02–1.31)a | 1.26 (1.05–1.50)a | |
2010 | 0.97 (0.87–1.08) | 1.16 (0.98–1.38) | 1.27 (1.06–1.53)a | |
2011 | 0.98 (0.88–1.08) | 1.15 (1.02–1.29)a | 1.28 (1.09–1.50)a | |
Age, years | <30 (referent) | |||
30–39 | 1.03 (0.97–1.08) | 1.01 (0.92–1.11) | 1.02 (0.98–1.06) | |
40–49 | 1.01 (0.93–1.08) | 1.05 (0.96–1.14) | 1.02 (0.97–1.07) | |
≥50 | 1.02 (0.94–1.10) | 1.08 (0.98–1.19) | 1.05 (1.00–1.10) | |
Sex | Male (referent) | |||
Female | 1.03 (0.99–1.08) | 0.95 (0.91–0.99)a | 0.99 (0.96–1.02) |
CI, confidence interval; aPR, adjusted prevalence ratios.
Multi-variable analyses adjusted for all factors listed in table.
aStatistically significant adjusted prevalence ratios.
Characteristic . | Category . | Support for complete ban on all tobacco advertisements aPR (95% CI) . | Support for increased price on tobacco products aPR (95% CI) . | Support for comprehensive smoke-free policies in public places aPR (95% CI) . |
---|---|---|---|---|
Perception that the tobacco industry should be allowed to sponsor school events | No (referent) | |||
Yes | 0.89 (0.84–0.95)a | 1.02 (0.95–1.10) | 0.95 (0.92–0.98)a | |
Belief that the tobacco industry encourages youths to use tobacco products | No (referent) | |||
Yes | 1.27 (1.17–1.37)a | 1.13 (0.99–1.28) | 1.02 (0.98–1.05) | |
Perception that teachers' tobacco use influences youths to use tobacco products | No (referent) | |||
Yes | 1.01 (0.90–1.14) | 1.14 (0.86–1.50) | 1.13 (1.03–1.24)a | |
Extent involved in teaching about health | Not at all (referent) | |||
Not primary duty, teach sometimes | 1.06 (1.01–1.11)a | 1.12 (1.02–1.24)a | 1.02 (0.99–1.06) | |
Primary duty, teach a lot | 1.05 (1.01–1.10)a | 1.09 (0.99–1.19) | 1.02 (0.98–1.06) | |
Current smoking status | Nonsmoker (referent) | |||
Smoker | 1.05 (0.96–1.14) | 0.74 (0.62–0.88)a | 0.98 (0.91–1.05) | |
Type of school personnel | Teacher (referent) | |||
Administrative | 1.02 (0.97–1.08) | 0.95 (0.86–1.04) | 1.04 (1.01–1.08)a | |
Region | Southern Africa (referent) | |||
West Africa | 1.16 (1.05–1.28)a | 0.97 (0.87–1.07) | 1.03 (0.97–1.09) | |
Central Africa | 1.05 (0.94–1.17) | 0.90 (0.82–0.99) | 1.00 (0.95–1.06) | |
Eastern African | 0.95 (0.86–1.05) | 0.93 (0.87–1.00) | 0.99 (0.93–1.06) | |
Northern Africa | 1.17 (1.05–1.30)a | 0.91 (0.81–1.03) | 1.00 (0.93–1.07) | |
Year | 2006 (referent) | |||
2007 | 0.93 (0.84–1.02) | 1.17 (1.03–1.34)a | 1.21 (1.02–1.44)a | |
2008 | 0.95 (0.88–1.03) | 1.14 (1.02–1.28)a | 1.26 (1.07–1.48)a | |
2009 | 0.94 (0.86–1.04) | 1.15 (1.02–1.31)a | 1.26 (1.05–1.50)a | |
2010 | 0.97 (0.87–1.08) | 1.16 (0.98–1.38) | 1.27 (1.06–1.53)a | |
2011 | 0.98 (0.88–1.08) | 1.15 (1.02–1.29)a | 1.28 (1.09–1.50)a | |
Age, years | <30 (referent) | |||
30–39 | 1.03 (0.97–1.08) | 1.01 (0.92–1.11) | 1.02 (0.98–1.06) | |
40–49 | 1.01 (0.93–1.08) | 1.05 (0.96–1.14) | 1.02 (0.97–1.07) | |
≥50 | 1.02 (0.94–1.10) | 1.08 (0.98–1.19) | 1.05 (1.00–1.10) | |
Sex | Male (referent) | |||
Female | 1.03 (0.99–1.08) | 0.95 (0.91–0.99)a | 0.99 (0.96–1.02) |
Characteristic . | Category . | Support for complete ban on all tobacco advertisements aPR (95% CI) . | Support for increased price on tobacco products aPR (95% CI) . | Support for comprehensive smoke-free policies in public places aPR (95% CI) . |
---|---|---|---|---|
Perception that the tobacco industry should be allowed to sponsor school events | No (referent) | |||
Yes | 0.89 (0.84–0.95)a | 1.02 (0.95–1.10) | 0.95 (0.92–0.98)a | |
Belief that the tobacco industry encourages youths to use tobacco products | No (referent) | |||
Yes | 1.27 (1.17–1.37)a | 1.13 (0.99–1.28) | 1.02 (0.98–1.05) | |
Perception that teachers' tobacco use influences youths to use tobacco products | No (referent) | |||
Yes | 1.01 (0.90–1.14) | 1.14 (0.86–1.50) | 1.13 (1.03–1.24)a | |
Extent involved in teaching about health | Not at all (referent) | |||
Not primary duty, teach sometimes | 1.06 (1.01–1.11)a | 1.12 (1.02–1.24)a | 1.02 (0.99–1.06) | |
Primary duty, teach a lot | 1.05 (1.01–1.10)a | 1.09 (0.99–1.19) | 1.02 (0.98–1.06) | |
Current smoking status | Nonsmoker (referent) | |||
Smoker | 1.05 (0.96–1.14) | 0.74 (0.62–0.88)a | 0.98 (0.91–1.05) | |
Type of school personnel | Teacher (referent) | |||
Administrative | 1.02 (0.97–1.08) | 0.95 (0.86–1.04) | 1.04 (1.01–1.08)a | |
Region | Southern Africa (referent) | |||
West Africa | 1.16 (1.05–1.28)a | 0.97 (0.87–1.07) | 1.03 (0.97–1.09) | |
Central Africa | 1.05 (0.94–1.17) | 0.90 (0.82–0.99) | 1.00 (0.95–1.06) | |
Eastern African | 0.95 (0.86–1.05) | 0.93 (0.87–1.00) | 0.99 (0.93–1.06) | |
Northern Africa | 1.17 (1.05–1.30)a | 0.91 (0.81–1.03) | 1.00 (0.93–1.07) | |
Year | 2006 (referent) | |||
2007 | 0.93 (0.84–1.02) | 1.17 (1.03–1.34)a | 1.21 (1.02–1.44)a | |
2008 | 0.95 (0.88–1.03) | 1.14 (1.02–1.28)a | 1.26 (1.07–1.48)a | |
2009 | 0.94 (0.86–1.04) | 1.15 (1.02–1.31)a | 1.26 (1.05–1.50)a | |
2010 | 0.97 (0.87–1.08) | 1.16 (0.98–1.38) | 1.27 (1.06–1.53)a | |
2011 | 0.98 (0.88–1.08) | 1.15 (1.02–1.29)a | 1.28 (1.09–1.50)a | |
Age, years | <30 (referent) | |||
30–39 | 1.03 (0.97–1.08) | 1.01 (0.92–1.11) | 1.02 (0.98–1.06) | |
40–49 | 1.01 (0.93–1.08) | 1.05 (0.96–1.14) | 1.02 (0.97–1.07) | |
≥50 | 1.02 (0.94–1.10) | 1.08 (0.98–1.19) | 1.05 (1.00–1.10) | |
Sex | Male (referent) | |||
Female | 1.03 (0.99–1.08) | 0.95 (0.91–0.99)a | 0.99 (0.96–1.02) |
CI, confidence interval; aPR, adjusted prevalence ratios.
Multi-variable analyses adjusted for all factors listed in table.
aStatistically significant adjusted prevalence ratios.
Support for increased price on tobacco products
The prevalence of support for price increase on tobacco products ranged from 64.7% (Seychelles) to 93.3% (Mauritania), with a median support of 80.8% (Table 2).
School personnel who smoked cigarettes had significantly lower likelihood of supporting price increase on tobacco products compared with nonsmokers (aPR = 0.74; 95% CI 0.62–0.88) (Table 3). School personnel who taught about health sometimes had higher likelihood of supporting tobacco price increases compared with those who did not teach about health at all (aPR = 1.12; 95% CI: 1.02–1.24). The likelihood of support for tobacco price increases did not vary significantly by whether school personnel believed that the tobacco industry should sponsor school activities, or if they believed that the tobacco industry targets youths with tobacco products. Similarly, no significant differences in support were observed by age, sex or type of school personnel.
Support for comprehensive smoke-free policies in public places
The prevalence of support for comprehensive smoke-free policies in public places ranged from 66.0% (Somaliland, Somalia) to 97.0% (Tunisia), with a median support of 92.4% (Table 2).
Support for comprehensive smoke-free policies in public places was significantly lower among school personnel who believed that the tobacco industry should be allowed to sponsor school activities (aPR = 0.95; 95% CI 0.92–0.98) (Table 3). Conversely, school personnel who believed that teachers' tobacco use influenced students to begin smoking were more likely to support comprehensive smoke-free policies in public places (aPR = 1.04; 95% CI 1.01–1.08). School administrators were more likely to support comprehensive smoke-free policies in public places compared with classroom teachers (aPR = 1.04; 95% CI 1.01–1.08). Support for comprehensive smoke-free policies in public places was significantly higher in every other year compared with 2006. No differences were observed by other assessed characteristics.
DISCUSSION
Our analyses showed greater likelihood of support for complete bans on tobacco advertisements among school personnel who believed the tobacco industry encouraged youths to smoke. However, support for complete bans of tobacco advertisements and smoke-free policies were significantly lower among school personnel who were in favor of tobacco industry-sponsored school events. These findings indicate that the perceptions and attitudes of school personnel toward tobacco industry activities may be important determinants of their support for tobacco control policies, or their unwitting involvement with indirect tobacco promotional activities. For example, an examination of data from Philip Morris International's 2012 corporate sponsorship activities showed that boards of education or school administrators were frequent recipients of tobacco industry sponsorship funding (Philip Morris International, 2012). School personnel's firm anti-tobacco position, and their uncompromising refusal of tobacco industry sponsorship activities in school, may help in protecting youths from tobacco industry influence related to all forms of tobacco promotion.
Soliciting or accepting tobacco sponsorships for school activities poses a public health threat because this may provide avenues for tobacco industry representatives to get in close contact with youths and target them with tobacco products, brand, logos or colors. Research has shown that the ability of youths to identify tobacco brands may be associated with increased susceptibility to tobacco use (Maziak et al., 2003; Blecher, 2008; Lovato et al., 2011; Borzekowski and Cohen, 2013). However, even in the absence of direct tobacco advertising at such industry-sponsored school activities, tobacco industry contribution to such events directly or indirectly—using financial or other in-kind contributions—is in of itself a form of tobacco promotion and should be prohibited as part of a comprehensive ban on tobacco advertisement (WHO, 2003). The tobacco industry has often used contributions to deserving causes as a public relations strategy to improve its corporate image and societal acceptance (Tesler and Malone, 2008; McDaniel and Malone, 2012). Not to be overlooked also is the ethical dilemma of accepting sponsorship from an industry that has been charged with racketeering, and whose activities directly result in millions of preventable deaths globally every year (Campaign for Tobacco-Free Kids, 2013; U.S. DHHS, 2010).
Strict monitoring and enforcement of policies prohibiting tobacco advertising and sponsorship may be complemented and facilitated by strong public education and community awareness programs about the dangers of tobacco use (WHO, 2003). Teachers and educators in particular are significant members of the community and may have strong influence on community attitude and behavior, including lifestyle behaviors like tobacco use. It is therefore important to engage teachers as stakeholders in tobacco control policies as this may help to build support for, and increased compliance with such policies (Trinidad et al., 2005). The fact that support for complete bans on tobacco advertisements was higher among school personnel who believed that the tobacco companies deliberately try to encourage youths to smoke, and those who taught about health (and conceivably knew more about the harmfulness of tobacco use), further underscores the need to increase the awareness of school personnel about tobacco industry's strategies and the dangers of tobacco use and secondhand smoke exposure. Ultimately, the complete ban of tobacco industry sponsorships and other forms of tobacco advertisements and promotion is the most effective strategy to reduce youth's exposure to pro-tobacco influences (U.S. DHHS, 2012; WHO, 2013a,b), but this may be dependent on political will, public support, and extent of tobacco industry lobbying.
The findings in this study are subject to some limitations. First, tobacco use and other measures were self-reported and may have been subject to misreporting. Furthermore, the cross-sectional nature of the study precludes any causal inferences and only associations can be inferred. Finally, since nationally representative data were not available for all countries within each United Nations region, these findings may not be representative of the respective regions. Despite these limitations, this study underscores the need to educate school personnel on industry strategies to increase support for tobacco control policy in Africa.
CONCLUSION
Overall, the majority of school personnel were in support of comprehensive tobacco control measures. However, school personnel who believed that the tobacco industry should be allowed to sponsor school events were less likely to support complete bans on tobacco advertisements and smoke-free laws in public places. In contrast, those who believed that the tobacco industry deliberately tries to encourage youths to smoke had higher likelihood of supporting complete bans on tobacco advertising. These findings underscore the need to engage teachers' in tobacco control efforts by educating them on tobacco industry's strategies to undermine tobacco control policies.
ACKNOWLEDGEMENTS
I.T.A. contributed to the reported research while affiliated with the Center for Global Tobacco Control at Harvard University. He is currently affiliated with the Centers for Disease Control and Prevention's Office on Smoking and Health. The research in this report was completed and submitted outside of the official duties of his current position and does not reflect the official policies or positions of the Centers for Disease Control and Prevention. This study was supported with funding from the American Cancer Society.