1.1 Background to the Study
The impact of smoking and tobacco use on health cannot be over emphasized. Cigarette smoking remains a gigantic public health problem and is still regarded as one of the leading preventable causes of morbidity and mortality worldwide (Can, Topbas, Ozuna, Ozgun, Can & Yavuzyilmaz, 2009; Mpabulungi & Muula, 2004; Salawu, Danburam, Desalu, Olokoba, Agbo & Midala, 2009; World health Organisation, 2015). It is well-known that many smokers start before the age of 18 years, however, it is of great interest to know that the increasing trend in smoking prevalence amongst youths and the likelihood that many of these young people who begin to smoke at an early age, will continue to do so throughout adulthood (Adebiyi, Faseru, Sangowawa & Owoaje, 2010).
Although tobacco use has declined in many high income countries such as the United States and United Kingdom, it is increasing in many low and middle income countries (Boutayeb & Boutayeb, 2005; Warren, Jones, Eriksen & Asma, 2006) and in current situation, tobacco smoking is by far the most popular form of smoking and is practiced by over one billion people in the majority of all human societies (Akinpelu, 2015). Tobacco is the most common hazardous substance and this is aided by its legally availability, heavy promotion and wide consumption and has been revealed to be problematic including other forms of use other than cigarettes, which is on the rise among adolescents in many countries, and is likely to jeopardize progress in reducing chronic diseases and tobacco-related mortality (CDC, 2010; Warren et al., 2006).
The constant increase in the consumption of tobacco among adolescents is emerging as a complex and multidimensional problem (Soni & Raut, 2012). Melgosa (2006) rightly considers tobacco as a drug with the lowest risk, in the short term but one which takes away health and life from the greatest number of people in the long term.
Cigarette smoking is said to be responsible for over 25 diseases in humans some of which include: ischemic heart disease, chronic bronchitis and cancers of the lung, oral cavity, urinary bladder, pancreas, and larynx (Desalu, Olokoba, Danburam, Salawu & Issa, 2008). Over the past four decades, tobacco use has caused an estimated 12 million deaths in the world, including 4.1 million deaths from cancer, 5.5 million deaths from cardiovascular diseases, 2.1 million deaths from respiratory diseases and 94,000 infant deaths related to mothers smoking during pregnancy (WHO, 2009; Centers for Disease Control and Prevention, 2002; Ekrakene & Igeleke, 2010) and on average cigarette smokers lose about 15 years of their life (The global tobacco survey collaborative group, 2002; Raji, Abubakar, Oche & Kaoje, 2013).
It is estimated that number of deaths due to tobacco will increase from 3 million per year worldwide to 70 million per year by 2025 (Reddy & Arora, 2005; US Department of Health and Human Services, 2012). It has been said that adolescents are especially vulnerable to these effects and may be more likely than adults to develop an addiction to tobacco (Chakraborty, 2009). In addition, it has been predicted that if the pattern currently seen among youth continues, a lifetime of tobacco use would result in the deaths of 250 million children and young people alive today, most of them in developing countries (WHO, 2012).
Like other developing countries, the most susceptible age for initiating tobacco has been found between the ages of 15-24 years as evident in the study by Gboyega, Adesegun and Chikezie (2013) identifying youths as a major group involved in smoking over the last two decades, an age group where most are expected to be in school. Educational attainment is widely regarded as an important health risk factor because of how strongly it has been associated with health outcomes, health-related behaviors, and other risk factors (National Center for Health Statistics, 1999). For the past 30 years, smoking prevention programmes have been focused almost exclusively upon youth, mainly within the school setting (Backinger, 2003; Ekanem, 2008; Salawu, Danburam & Isa, 2010; Fawibe & Shittu, 2011; Hammond, 2005; Nwafor, Ibe & Aguwa, 2012; Odukoya, Odeyemi & Oyeyemi, 2013; Okagua, Opara & Alex-Hart, 2015) despite School dropouts being more likely to smoke heavily than students (Aloise-Young, Cruickshank & Chavez, 2002). In Nigeria, the prevalence of tobacco use among youth tends to be higher than among adults (Odukoya, Odeyemi, Oyeyemi & Updhyay, 2013).