Factors associated with smoking among adult males, Sri Lanka- A cross sectional analytical study

Background Studies in developing and developed countries have assessed only a limited number of factors, for their association with smoking. However, literature indicates that factors are better assessed using a comprehensive model(PRECEDE) to identify Predisposing, Reinforcing and Enabling factors which initiate and maintain the smoking behaviour. This study aimed to determine the factors associated with smoking based on the PRECEDE model. Methods The two groups of ever smoker(n=624) and never smoker(n=530) males of aged 20-59 years were identified in a community based household survey in Colombo district Sri Lanka. Post hoc sample size estimation indicated a power of 82% for the smallest factor which showed a significant association. The information on predisposing, reinforcing and enabling factors associated with smoking was gathered using an interviewer-administered questionnaire designed based on the PRECEDE model. Results Age more than 40 years(p<0.01), low educational level(p<0.001), being married(p=0.002), not doing a job(p<0.01), unfavourable attitudes promoting smoking were found to be significant predisposing factors associated with smoking(p=<0.001). History of smoking by the father(p<0.001), having a family member smoking(p=0.004), had a close friend smoked regularly(p<0.001) and offered tobacco products(p<0.001) and getting frequently invitations to parties where friends regularly smoke(p<0.001) were factors that reinforced smoking habit of adult males when they were younger. Enabling factors assessed among ever smokers indicated that a majority (92%) who started smoking at the younger age have bought the tobacco products by themselves, while 13.4% have bought the tobacco products as packets and 91.4% as single/multiple sticks. Most of the ever smokers (93.7%) have said that there was a place to buy tobacco products near their house/ school/ work station. Conclusion Factors that were found to be associated with smoking among adult males, Sri Lanka were mostly modifiable. The study recommends comprehensive intervention programs targeting adult males designed to prevent smoking by addressing the modifiable factors.