Potential roles of school administrators and community-residing adults in tobacco use prevention in Nigerian college students: a viewpoint

Introduction

Tobacco use is considered a key risk factor for the development of coronary heart disease, stroke, and peripheral vascular disease. ¹ Despite the well-established adverse effects of tobacco on heart health, and the existence of key measures to decrease tobacco-related mortality and disease, there is little awareness among large sections of the population that tobacco is one of the foremost causes of cardiovascular diseases (CVDs). ¹ The promotion of tobacco use control is crucial to minimize non-communicable diseases and to attain sustainable development health goals. As the World Heart Foundation ² is aiming to achieve an approximate 25% global reduction in premature deaths from CVDs by 2025, cross-disciplinary contributions and knowledge sharing regarding more feasible ways of achieving this goal are required. To this end, the World Health Organization’s theme for this year’s World No Tobacco Day is “Tobacco and heart disease.” This year’s event aims to increase awareness of the connection between tobacco and heart disease and other CVDs, and to increase awareness of possible measures that key stakeholders, including governments and the public, can take to decrease the risks to heart health from tobacco use. ¹ As educators, we hope to contribute to the realization of these objectives and support global efforts toward tobacco control by highlighting the possible roles of education stakeholders, such as school administrators and community adult members, in supporting the student population in refraining from tobacco use.

Previous studies have shown that tobacco use is becoming pandemic among college students.^e.g.,3–10 In addition, current estimates indicate that direct tobacco use causes approximately five million premature deaths worldwide annually. ¹¹ By 2030, deaths attributable to tobacco use are projected to increase to 8.3 million, and up to 6.8 million of these (more than 80%) will be in low-and middle-income nations.^11,12 Additionally, approximately 600,000 individuals are expected to die from the harmful effects of secondhand smoke. ¹³

Tobacco use could result in the deaths of over one billion people worldwide in this century; ¹⁴ therefore, it is essential that knowledge is shared about how stakeholders could contribute to the global efforts toward tobacco control and that feasible measures are adopted. Knowledge sharing regarding the roles of various stakeholders in tobacco control may also contribute to the attainment of the United Nation’s Sustainable Development Goal 3, which aims to ensure healthy lives and well-being for everyone at all ages by 2030. ¹⁵ To this end, as educators, we aim to add to the academic literature on tobacco use prevention by discussing the possible roles of school administrators and community-residing adults in tobacco use prevention for college students in Nigeria. Such prevention efforts are important, because tobacco use in college students may be linked to problematic behaviors such as truancy, gangsterism, and illicit sexual behavior.^16,17

On October 1, 1990, the Nigerian government issued the Tobacco Control Act to curtail tobacco smoking in certain places (such as schools, marketplaces, cinemas, offices, shopping malls, and public buildings) and to limit tobacco advertising. ¹⁸ There have been plans for legislation to control tobacco use, consumption, and sales in Nigeria since the 1990s. In 2015, the Nigerian government implemented the National Tobacco Control Act. ¹⁹ However, many Nigerian college students are still able to access and use tobacco products. A Nigerian study showed that 80.9% of college students were current smokers, more than 35.3% had no intention to quit smoking, 52.0% of students smoked cigarettes every day, one-third of these student smokers had started smoking cigarettes prior to 15 years of age and 28.4% had smoked for more than 10 years. ¹⁰ Tobacco use prevalence among high school students is higher than among middle school college students. ²⁰

There are many channels through which college students in Nigeria can obtain tobacco. Common sources include peers, co-smokers, retailers, family members, and media advertisements.^21,22 A recent study showed that the most common risk factors for tobacco use among the Nigerian college-aged population include peer influence, family conditions, and media advertisements. ²² Research also shows that even low-risk college students in high-risk colleges are more than twice as likely to have initiated tobacco use compared with low-risk students in low-risk colleges. ²³ Thus, college environment characteristics may affect those students who are least vulnerable to tobacco use initiation.

We believe that school administrators can play a significant role in supporting community health awareness campaigns and school health interventions for tobacco use prevention, initiating anti-tobacco school clubs, sensitizing and educating all school personnel by incorporating tobacco-related themes into the school curriculum, and organizing professional development courses, educational conferences, seminars, and workshops for teachers and college students. School administrators must ensure that courses on tobacco use are integrated into the school curriculum to reduce smoking among college students. ²² Administrators also have to ensure that their school has the psychoeducational resources that teachers require to educate students about the harmful effects of tobacco use. ²⁴ School administrators need to encourage students and school personnel to participate in school- and community-based tobacco control and cessation programs, as such programs can have a substantial impact. ¹⁶ Because the pattern of tobacco use is influenced by several factors,^25–28 school administrators should support school-based periodic surveillance surveys of tobacco use trends among students and staff. ²⁹ School administrators should also support clinicians and researchers to assess the outcome of interventions on tobacco use prevention among college students and staff. ³⁰ It is also crucial for administrators to grant informed consent to prospective researchers to enable them to observe age trends in tobacco use initiation and the incidence of tobacco use patterns among students. ²⁸ School administrators must support and implement evidence-based measures to reduce tobacco use among college students ³⁰ and promote students’ engagement in tobacco-related prevention education and advocacy activities. ²⁸ School administrators can also increase college students’ awareness of tobacco-related harm using the media. ³⁰

As many adult smokers became addicted to tobacco during adolescence,^24–29 engaging community-residing adults in tobacco use control and prevention programs organized by both schools and communities may help to reduce tobacco use among college students. The engagement of community members in tobacco control discourse is crucial to ensure significant changes in how tobacco products are marketed, sold, and utilized. ³⁰ Community-residing adults can help to achieve Sustainable Development Goal 3 by supporting effective community-based clinical trials designed to minimize passive and active smoking in their communities.^31–35 Community-residing adults must also support community interventions that oppose tobacco industry marketing, assist in preventing tobacco use initiation among community-dwelling college students, promote quitting among community-dwelling students, help to eradicate the extent to which students are exposed to secondhand smoke, identify and eliminate inequalities linked to tobacco use at the community level, and support tobacco-free social norms.^33–36

Community-residing adults could also help to mobilize other community members to assist in restricting college students’ access to tobacco products. ³⁵ This restriction could be implemented along with other interventions, such as stricter local laws targeting retailers, active enforcement of retailer sales laws, and retailer education combined with incentives within the community. ³⁰ Finally, it is important to note that the feasibility of such community-oriented roles and school-related strategies for tobacco use prevention among college students is supported by previous research findings.^e.g.,31–36

Evidence suggests that tobacco use prevention among college students should be a high priority for any nation.^37,38 Thus, the need for school administrators and community-residing adults to identify future directions in tobacco use control and prevention among college students cannot be overemphasized. Empirical studies are needed to clarify the roles that school administrators and community adults play in reducing the prevalence of tobacco use among students and school staff in Nigeria. There is also a need for prospective research to promote the integration of smoking prevention education into the training of current college students, who are prospective mentors, teachers, and models, to equip them with basic information to educate future generations of students on the harmful effects of smoking in middle- and low-income nations. ¹⁰ Additional research is required to address the limitations of previous school- and community-based interventions aimed at reducing tobacco use among college students.

Conclusion

In this article, we have highlighted the possible roles of school administrators and community adult members in supporting college students in Nigeria in refraining from tobacco use. Attention was drawn to this year’s commemoration of the World No Tobacco Day, which focuses on the global impact of tobacco on cardiovascular health. We noted that various stakeholders, including school administrators and community-residing adults, have important roles to play in providing community- and school-level support to college students to enable them to refrain from tobacco use. However, research is needed to empirically substantiate whether and how school administrators and community-residing adults have influenced college students in Nigeria in refraining from tobacco use.