Cigarette Smoking in Male High School Students in Myanmar: Developmental Differences in Risk and Promotive Factors

Tobacco use is a significant concern in Asia. However, a paucity of research has assessed risk and promotive factors for youth tobacco use beyond demographics, or has systematically evaluated developmental differences in patterns of risk and promotive factors associated with tobacco use in this region. This study addressed this knowledge gap, with the goal of informing prevention approaches. Male public high school students (N = 842; M = 15.47, SD = 1.13 years) in Myanmar completed an adapted version of the Communities That Care (CTC) survey and questions on past month cigarette use. A series of path models and multiple group analyses were used to evaluate the associations of risk and promotive factors to current cigarette use, and age differences in these patterns. For both younger and older adolescents, associating with more drug-using peers increased the risk of tobacco use. For younger males, favorable attitudes toward antisocial behavior and poor family management were additional risk factors for tobacco use; for older males, parental attitudes favorable towards drug use and poor school achievement heightened students' risk. Unexpectedly, parental attitudes favorable towards antisocial behavior was associated with a lower likelihood of older males' smoking. Decreased risk of cigarette use was linked to opportunities for prosocial family involvement in younger males, and with rewards for prosocial community involvement in older males. These results suggest that interventions to reduce cigarette use in Myanmar should target different levels of male adolescents' social ecologies, and attend to developmental differences in patterns of risk and protection.