Prevalence of cigarette smoking among secondary school students - Budapest, Hungary, 1995

Morbidity and Mortality Weekly Report, Jan 24, 1997

Because of the high prevalence of tobacco use in countries of Central and Eastern Europe, public health officials in many of these countries have designated as a priority the prevention of smoking initiation among youth. In 1995, a nationally representative survey in the Republic of Hungary documented that 35.8% of 16-year-old students in that country had smoked cigarettes during the preceding 30 days (1). To better characterize smoking among youth in Hungary, the Field Epidemiology Training Program, Hungarian Ministry of Welfare, conducted a cross-sectional survey in Budapest (1995 population: 1,906,798) among secondary school students aged 14-18 years. Specific objectives of the survey were to assess the prevalence of cigarette smoking among these students, determine factors associated with higher prevalences, and describe the smoking habits of current cigarette smokers. This report summarizes the findings, which indicate that one third of all students smoked; half of all 18-year-olds smoked; and of those students who smoked, 41% most frequently smoked an imported, internationally recognized cigarette brand.

Among the 105,209 Budapest students aged 14-18 years, approximately 80% attended traditional public high schools, and 20% attended public vocational/technical schools. A sample of students was selected from a stratified sample of the 199 secondary schools in Budapest. Twenty (80%) traditional high schools and five 20% vocational/technical schools were selected with a probability proportional to their size. Classrooms in these 25 schools were then randomly selected. During 3 weeks in January 1995, all 2878 students in attendance completed a pretested, standardized questionnaire that included questions translated from the U.S. Youth Risk Behavior Survey (2) and that asked about culturally relevant factors possibly associated with smoking. Current smokers were defined as students who reported having smoked at least one cigarette during the preceding 30 days. Of the 2878 students, 79 (2.7%) were excluded because their smoking status could not be determined. Epi Info 6.02 was used for data analysis that accounted for the stratification and clustering of students within classrooms; 95% confidence intervals (CIs) were calculated using SUDAAN (3).

Among the 2799 students, 987 (35.3%) (95% CI=30.6%-39.9%) reported current smoking (Table 1). Although the prevalences were similar among male and female students (prevalence odds ratio [POR]=1.0; 95% CI=0.8-1.5), students aged 18 years were more likely to smoke than students aged 14 years (47.9% and 23.8%, respectively [POR=2.9; 95% CI=1.3-6.6]). The prevalences of current smoking also were higher among vocational/technical students than traditional high school students (53.1% and 31.0%, respectively [POR=2.5; 95% CI=1.6-3.91); among students whose friends smoked than those whose friends did not smoke (42.6% and 6.8%, respectively [POR=10.1; 95% CI=7.5-13.7]); among students who reported that they had seen a teacher smoking during the school year than those who had not seen a teacher smoking (37.3% and 19.0%, respectively [POR=2.5; 95% CI=1.8-3.61); and among students with a family member who smoked than students whose family members abstained from smoking (40.7% and 27.0%, respectively [POR=1.9; 95% CI=1.6-2.1]). The prevalences of smoking were similar among students who received instruction at school about the harmful health effects of smoking and among those who did not receive such instruction (POR=1.0; 95% CI=0.9-1.1).

TABLE 1. Number and percentage of current smokers(*) among secondary school students aged 14-18 years, by selected characteristics -- Budapest, Hungary, 1995

                                             Current smokers
Characteristic    Sample size([dagger])    No.            (%)

Sex
  Male                   1470              525           (35.7)
  Female                 1324              461           (34.8)

Age (yrs)
  14                      168               40           (23.8)
  15                      720              191           (26.5)
  16                      806              286           (35.5)
  17                      696              274           (39.4)
  18                      399              191           (47.9)

School type
  Vocational/
    technical             537              285           (53.1)
  Traditional
    high school          2262              702           (31.0)

Total                    2799              987           (35.3)

                            Current smokers
Characteristic           (95% CI([sections]))

Sex
  Male                      (28.5%-42.9%)
  Female                    (32.2%-37.5%)

Age (yrs)
  14                        (23.0%-24.7%)
  15                        (20.5%-32.6%)
  16                        (27.6%-43.4%)
  17                        (34.6%-44.2%)
  18                        (32.9%-62.9%)

School type
  Vocational/
    technical               (46.7%-59.5%)
  Traditional
    high school             (26.2%-35.9%)

Total                       (30.6%-39.9%)