Exploring In-School Adolescent Smoking Behaviors: A Comparative Study of Rural and Urban Contexts in Anambra, Nigeria

The use of tobacco among adolescents is a big public health issue in low- and middle-income countries of the world including Nigeria. The aim of this study was to compare prevalence and determinants of tobacco use among in-school adolescents’ resident in urban and rural secondary schools in Anambra State. A cross-sectional analytical design was observed using multi stage random sampling to sample 360 students from some selected schools. A pretested, semi structured questionnaire adapted from the Global School Health Survey (GSHS) was used to collect data. The data was analyzed by descriptive and inferential statistics. Similar prevalence of tobacco use was found in both the urban (6.3%) and in the rural (6.5%) sites, without significance in either (p=1.000). Participation in protective factors including health education programs in which participants are educated on smoking dangers and sexually transmitted diseases (STDs) in particular was associated with non-smoking behavior significantly more in urban areas. On the other hand, being urban adolescents who reported tobacco use showed significantly association with risk factors such as poor school environment and bullying. Consequently, no difference in rates of tobacco use occur between urban and rural adolescents, despite differences in protective and risk factors. Recommendations aimed at strengthening health education, and improving school environments and reducing bullying are suggested to reduce adolescent smoking in these settings. Effective tobacco control of Nigerian adolescents requires targeting of public health interventions on the basis of the socio-cultural context.