CIGARETTE SMOKING AMONG COLOMBIAN HIGH SCHOOL STUDENTS : GENDER RELATED PSYCHOSOCIAL FACTORS

This study aimed to establish the prevalence of daily cigarette smoking (DCS) and its gender correlated factors in high-school attending adolescents from Bucaramanga, Colombia. A random cluster sample was surveyed (N = 2291). The previous month DCS prevalence was 11.6% (95% CI 9.7-13.5) in boys and 4.4% (95% CI 3.35.5) in girls. In girls, DCS was associated with previous month illegal substance use (OR 8.13, 95%CI 3.5218.87), abusive alcohol consumption (OR 5.88, 95% CI 2.54-13.70), being the best friend of a smoker (OR 3.25, 95% CI 1.38-7.63), and poor or mediocre academic achievement (OR 2.46, 95% CI 1.25-4.85). In boys, DCS was related to previous month substance use (OR 6.23, 95% CI 3.62-10.71), being the best friend of a smoker (OR 5.87, 95% CI 2.93-11.76), poor or mediocre academic achievement (OR 2.09, 95% CI 1.34-3.24), and being older than non-smokers (OR 1.48, 95% CI 1.21-1.81). DCS presents associated factors very similar for girls and boys. Thus, more research is needed.

Few studies report daily cigarette smoking prevalence during the previous month among highschool adolescents.The prevalence of DCS is between 1.3% and 23.0% depending on gender, grade, ethnicity and religion (4)(5)(6)(7)(8) .Studies on Colombian cigarette smoking among high school students are scarce (9)(10)(11) .One research reported prevalence of daily cigarette smoking of 7.7% among 11 th grade students in Medellín (9) and another found prevalence of 16.0% in high school students (10 th and 11 th grade) from Bucaramanga (10) .These studies used the same questionnaire for substance use epidemiological survey (VESPA), however, this instrument is sufficiently accurate if cigarette consumption occurs everyday during the previous month.Another study documented that 11.0% of 10 th grade students enrolled in public schools in Bogotá had smoked every day in the previous month (11) .
DCS is associated with sociodemographic characteristics like being a male (4)(5)(6) and a Caucasian instead of an Afro-American or a Latin-American (6)(7) ; with individual characteristics, for instance, low selfperceived academic ability (11) ; and also with contextual factors, that is, smoking among parents, siblings and friends (5)(6)(7)(8) , and other health risk behaviors like abusive alcohol consumption or illegal substance use (11) .
DCS is a public health problem that starts in early adolescence and consolidates in late adolescence or early adulthood (1) .DCS could be prevented if factors related were known and handled from the beginning.To identify adolescents with abusive alcohol consumption, the CAGE questionnaire was used.
Scores similar or higher than three was considered positive (12) .This scale has presented good sensitivity

RESULTS
A group of 2.304 students completed the survey.Thirteen (0.56%) students were excluded because they reported inconsistencies or did not complete the questionnaires.A total of 2291 questionnaires were analyzed.
Fifty four percent of the population was male.
Ages ranged from 12 to 20 years; the mean age was 15.9 (SD 1.09); mean was 16.

DISCUSSION
This investigation reports an important prevalence of DCS in high school students in Bucaramanga, Colombia.DCS was strongly associated with substance use, the best friend being a smoker, and poor or mediocre academic achievement, in both females and males.Some researchers have reported on the prevalence among adolescents (4)(5)(6)(7)(8)11) . In Uited States, 21.9% of high school attending students had smoked at least once within the previous 30 days, and 9.7% had smoked 20 or more times in the previous 30 days.However, this study omitted information about DCS (13) , 10.2% of a representative sample of 6,504 adolescents residing in the United States, smoked 26-30 days within past month (14) .Other investigations reported everyday cigarette smoking in the previous 30 days.
One study reported a prevalence of 19.4% in students from different ethnic residents in United States (4) .Among Muslim Arab-American adolescents, 12% of them were daily cigarette smokers (5) .It was also observed in the United Stated that 18.0% of middle-, junior-, and high-school students were regular smokers during the previous 30 days (6)   .In Portugal, 1.3% of thirteen-year old students were daily smokers (7) .Icelandic adolescent students 8.8% reported daily smoking (8) ; and in Colombia, 11.0% of 10 th grade students of public schools (11) .
Regarding gender, data are consistent with previous reports, that is, the prevalence of DCS is higher in boys than in girls (5,11,(13)(14) However, one research found that girls were most often daily cigarette smokers than boys (7) .Behavioral risks related to DSC, and their strength, are a little different for females and males.Although, after adjusting for potential confounding variables, it was found that abusive alcohol consumption was a factor associated with DSC for females but not for males.It is possible that sociocultural factors can explain this divergence.
However, these findings need further investigation.
DCS was also related to substance use and poor or mediocre academic achievement during the previous month.Previous studies have reported similar findings (5,11)   .It has been proven that cigarette smoking is a gateway to other and more problematic substance consumption (11)  more likely to become a smoker than one who does not have a close smoker friend (5)(6)(7)(8)(9) .
Smoking is associated to eating disorders symptoms.The present study does not corroborate this association.Probably, sociocultural factors are playing an important role.Eating disorders are strongly related to environmental causes.
Smoking is a main medical concern.At least a quarter of DCS adolescents meet criteria for nicotine dependence, and this population represents a real public health problem.Adolescents who establish a daily pattern of cigarette consumption have more difficulty quitting smoking and present a higher risk for tobacco related diseases (3) .Thus, it is important to start smoking prevention programs during childhood and early adolescence (15) , and identify experimenters and occasional smokers before they establish daily cigarette use to prevent future problems (3)(4)(5) .
This study present some limitations.First, it is a cross-sectional investigation and secondly, emotional symptoms such as depressive ones were not controlled for.The conclusion is that almost one of each 12 high school students presents DCS; DCS is related to substance use during the previous month, being the best friend of a smoker and presenting poor or mediocre academic achievement within the previous month, both for females and males.Therefore further research is needed.

(
60-90%) and acceptable specificity (40-60%) in several populations.To estimate the presence of potential eating disorders, adolescents filled out the SCOFF questionnaire.This five-item tool was designed to screen eating disorders symptoms among girls.Two or more positive answers are suggestive of eating disorders.This scale has been validated with Colombian female students.The Statistical Package for Social Sciences for Windows (SPSS for Windows 12.0) was used for all analyzes.Differences were determined establishing prevalence ratios (PR) for categorical variables.PR is recommended for cross-sectional studies instead of OR (Odds ratio).To compare means and standard deviations (SD) the Student's t test is used.A logistic regression was used for multivariate analysis.The final model included variables that reached p-values lower than 0.20 according to Greenland's recommendations.The Hosmer-Lemeshow goodnessof-fit test was used to examine the fitness of the logistic models.It is known that the internal consistency of a scale is a property of a population, thus, the internal consistency of the CAGE and the SCOFF questionnaires in this sample was measured through the Kuder and Richardson's formula 20.This statistical test is mathematically equivalent to Cronbach's alpha and it is used when the scale has a dichotomous answer pattern.

Table 2 -
Daily cigarette smoking among high-school After controlling confounding variables in females, DCS was associated with the use of any substance during the previous month, abusive alcohol consumption (CAGE positive), being the best friend of a smoker, and also with poor or mediocre academic An adolescent with a close friend who is a smoker is Daily cigarette smoking among colombian high school… Martínez-Mantilla JA, Amaya-Naranjo W, Alfredo Campillo H, Díaz-Martínez LA, Campo-Arias A.
It is well known that a very important factor for starting smoking is related to social influences.