Uruguayan secondary school students speak up about tobacco: results from focus group discussions in and around Montevideo

Abstract

This qualitative research study investigated intrapersonal, interpersonal, and environmental factors that shape young adolescent tobacco use behaviors in Uruguay. Focus groups were conducted in the summer of 2012 and fall of 2013 in four secondary schools in Montevideo, Uruguay, including two private schools and two public schools. A total of four focus groups were led in each school, composed of 4-6 students each, 16 focus groups in total. Data analysis utilized NVivo software and included deductive and inductive content analysis. Overwhelmingly, students reported that the onset of smoking occurred in the second year of secondary school. The primary intrapersonal factors that were found to be universal among respondents identified that smoking was a performance in groups, to garner attention from their peers. Students interviewed most often stated that the greatest interpersonal factors for smoking were to look older, as a rite of passage, and for group membership. Environmental factors cited most often indicate that they smoked during unsupervised time, either at night or around the short Uruguayan school day. Focus group interviews revealed that adolescents had easy access to cigarettes for purchase through small family owned grocery stores, even though laws exist preventing the sale of cigarettes to minors. Few differences were cited between strata related to cigarette use in adolescents. The differences that do exist are most apparent across gender, though there were a few observed differences when stratified by public and private school. Findings from this study indicate that key factors across ecological levels (intrapersonal, interpersonal, and environmental) should be taken into consideration when designing tobacco prevention programs for youth in Uruguay. A multiple-component approach which addresses risk factors at all of these levels, implemented in schools, may be particularly well-suited to this setting.

¡Activate Ya! Co-learning about school-based tobacco prevention and physical activity promotion in secondary school students in Uruguay

“…The intervention aimed to: (a) increase knowledge about the negative health effects of smoking and decrease outcome expectations (reasons to smoke) and normative beliefs supportive of cigarette smoking; (b) increase self-efficacy, outcome expectations (perceived enjoyment) , and perceived social support for PA; (c) foster a supportive school environment including student-school connectedness (9); and (d) promote a healthy PA self-concept , as adolescents with a stronger PA self-concept engage in more PA (16) and less cigarette smoking (17). Intervention development was led by a planning group comprised of Uruguayan teachers and public health practitioners and researchers, with key activities that included student focus groups to better understand the targeted behaviors and context (18,19), a pilot test of the afterschool program in 2014, and a pilot test of the entire program in 2015. Core program components included the following:…”

Perceptions of friendship, peers and influence on smoking according to socioeconomic status and tobacco control context: A systematic review and meta-ethnography of qualitative research

“…As with studies published before the introduction of comprehensive legislation, perceived norms were perceived to indirectly in uence smoking behaviour (45,(47)(48)(49). However, perceived norms were also thought to impact upon adolescent smoking patterns.…”

“…Six studies published after the introduction of comprehensive legislation contributed to data on contextual determinants (44)(45)(46)(47)(48)(49). Again, contextual themes comprised of culture, identity and socioeconomic status.…”

“…For some, being offered cigarettes in a group setting was seen to exert pressure on individuals to conform (47,49), whilst others reported more subtle forms of in uence and even feeling the need to support their smoking friends(63).…”

“…Six studies published after the introduction of comprehensive legislation reported smoking as being part of identity construction and performance (44)(45)(46)(47)(48)63). The main ndings within this theme showed that a number of individual determinants contributed to adolescents' decision to start, and continue, to smoke, with a large proportion of the data focusing on smoking as a way of developing a sense of identity.…”