Exposure to the advertisement of toombak at the point-ofsale among adolescents in Khartoum State, Sudan: A crosssectional study

Abstract

INTRODUCTION This study aimed to assess the association between toombak (smokeless tobacco) advertisement at point-of-sale (PoS) and its use among adolescents in Sudan. METHODS A cross-sectional school-based and self-administered questionnaire study was conducted. Schools were randomly selected using a one-stage stratified sampling procedure, during 2013-2014, as part of a larger research project focusing on the use of toombak among secondary school students in Khartoum State, Sudan. The sample size was 1526 students. Data were collected on exposure to toombak advertisement, social acceptability, perceived accessibility to toombak, susceptibility, and toombak use. RESULTS A total of 41.8% of the adolescents were exposed to an advertisement at PoS, while 12.5% perceived direct access to toombak, 5.3% reported that they were susceptible to use toombak, and 10.9% were ever toombak users. Exposure to the advertisement of toombak at PoS was found to be associated with the older age group (44.3%) (p≤0.05). Males were more than females (45.2% vs 38.8%; p≤0.05). Those exposed to toombak advertisements at PoS reported more social acceptability towards toombak (48.9% vs 37.6%; p≤0.001) and direct accessibility to toombak (68.8% vs 47.2%; p≤0.05). Ever toombak users reported higher exposure to advertisements than non-users (54.5% vs 40.3%; p≤0.001). CONCLUSIONS Exposure to toombak advertisements at PoS was found to be high and associated with increased toombak use in Khartoum State, Sudan, in addition to increasing social acceptability to its use and perceived easy accessibility. The current law, which bans toombak advertisement and promotion at PoS, needs to be enforced. AFFILIATION

Tobacco Use in Sudan: Prevalence, Patterns, and Determinants – A Systematic Review

“…A study to estimate the prevalence of shisha smoking among adolescents found that 13.4% was the overall prevalence of those who had ever smoked shisha and users were 16.8% males and 10.9% females [22]. Almahdi and colleagues [23] reported a prevalence of 10.9% for Toombak ever-users among students aged 13–16 years in Khartoum state and reported a similar Toombak prevalence among adolescents in Sudan in their study, which assessed the association between Toombak advertisement and its use [24]. Investigating the prevalence of tobacco use in Nile state, Idris and colleagues [5] reported a range from 1% to 2% among children and adolescents with an abrupt increase of up to 25% in late adolescence.…”

“…Ahmed [33] 1 1 1 1 1 −1 0 0 1 0 1 0 0 0 Idris et al [5] 1 1 1 1 1 0 0 0 1 0 1 0 0 0 Almahdi et al [13] 1 1 1 1 1 0 0 0 1 0 1 0 0 0 Mahmoud et al [11] 1 1 1 1 −1 0 0 0 1 0 1 0 0 0 Dirar [14] 1 1 1 1 1 0 0 0 1 0 1 0 0 0 Elamin et al [12] 1 1 1 1 1 0 0 0 1 0 1 0 0 0 Elmanna [18] 1 1 1 1 1 0 0 0 1 0 1 0 0 0 Osman et al [16] 1 1 1 1 1 0 0 0 1 0 1 0 0 0 Ahmed et al [17] 1 1 1 1 1 0 0 0 1 0 1 0 0 0 Almahdi et al [24] 1 1 1 1 1 0 0 0 1 0 1 0 0 0 Mohamedet al [19] 1 1 1 1 1 0 0 0 1 0 1 0 0 0 Othman et al [22] 1 1 1 1 1 0 0 0 1 0 1 0 0 0 Almahdi et al [23] 1 1 1 1 1 0 0 0 1 0 1 0 0 0 Elmosaad et al [26] 1 1 1 1 1 0 0 0 1 0 1 0 0 0 Gadalla et al [21] 1 1 1 1 1 0 0 0 1 0 1 0 0 0 El-Amin et al [25] 1 1 1 1 1 0 0 0 1 0 1 0 0 0 Atari [20] 1 1 1 1 1 0 0 0 1 0 1 0 0 0 Awooda and Shashati [29] 1 1 1 1 1 0 0 0 1 0 1 0 0 0 Awadalla et al [28] 1 1 1 1 −1 0 0 0 1 0 1 0 0 0 Almahdi et al [27] 1 1 1 1 1 0 0 0 1 0 1 0 0 0 Key A Was the research question or objective in this paper clearly stated? B Was the study population clearly specified and defined?…”

“…Although the current data show that Toombak is more prevalent among adults, yet this might not indicate decreased use among younger population, but may contribute that most of Toombak dipper never quit [33]. Hence, the current law which bans selling tobacco product to minors and bans Toombak advertisement and promotion at points of sale, needs to be enforced [34].…”

“…Two of the reviewed articles showed that the majority of tobacco users use tobacco outside home and schools [24, 26]. This suggests the potential influence of environment other than home and school; students who spent most of their time outside home were prone to tobacco use.…”

“…In line with the findings of other reviews which investigated the prevalence adolescents, Almutairi [32] got similar high range of prevalence among adolescents in Saudi Arabia, which was reported by various studies under investigation as 20-29%. Exposure to Toombak advertisements at points of sale was found to be high and associated with increased Toombak use in Khartoum State, Sudan, in addition to increasing social acceptability to its use and perceived easy accessibility can be a factor influencing this prevalence [24]. Due to non-enforcement of existing tobacco control policies in Sudan, the prevalence of Toombak dipping and smoking is increasing, particularly among the young population.…”