Predictors of smoking initiation among Thai adolescents from low-income backgrounds: A case study of Nakhon Pathom low-cost housing estates

INTRODUCTION: Globally, an estimated 1.3 billion people in the world smoke tobacco products, of which more than 8 million die annually. A disproportionate number of these deaths occur in low- and middle-income countries like Thailand. Over 19% (10.7 million) of the Thai population aged ≥15 years were estimated to be smokers; of these, 7.8% were aged 15–18 years. Nearly 1 in 10 Thai students is a current tobacco user; about 20% of these smokers had initiated smoking before their 10th birthday. This shows that early smoking initiation among Thai youths is indeed a public health problem. This study was conducted to examine the factors associated with smoking initiation among adolescents from low-income backgrounds. METHODS: A cross-sectional study was conducted among youth aged 15–18 years living in low-cost housing estates in Nakhon Pathom province between 1 December 2019 and 30 July 2020. A total of 290 participants were recruited by stratified random sampling. A proprietary questionnaire was used to collect the data, which were analyzed by binary logistic regression. RESULTS: Risk factors for smoking initiation were having one or both parents deceased (OR=2.28; 95% CI: 1.218–3.471, p=0.001), having divorced parents (OR=1.67; 95% CI: 1.158–2.509, p=0.013), and poor academic performance (OR=2.50; 95% CI: 0.133–3.551, p=0.032). Protective factors were having knowledge of cigarettes (OR=0.65; 95% CI: 0.179–0.895, p=0.004) and correct perception of legal public smoking places (OR=0.45; 95% CI: 0.140–0.850, p=0.025). CONCLUSIONS: To curb the risks of early smoking initiation among youths of low-income backgrounds, both education and health authorities need to collaboratively design interventions tailored to raise awareness of the negative health impacts of tobacco, improve the performance of underperforming students, and meet the social needs of students whose parents are either deceased or separated to improve their social ties.