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The 13th World Conference on Tobacco OR Health

Building capacity for a tobacco-free world

July 12-15, 2006, Washington, DC, USA

Thursday, July 13, 2006 - 12:00 PM

Design, Validation, and Administration of a Nationwide Survey of Adult Tobacco Use in Cambodia

Pramil N. Singh, Dr.PH1, Daravuth Yel, MD, MS2, Sinn Sovann, MD3, Jayakaran Job, MD, DrPH1, Emmanuel Rudatsikira, MD, MPH1, Floyd Petersen, MPH4, Susanne Montgomery, PhD5, Linda Hyder Ferry, MD, MPH5, and Synnove Knutsen, MD, PhD, MPH1. (1) Epidemiology, Loma Linda University, Nichol Hall Room 2010, School of Public Health, Loma Linda, CA 92350, (2) Tobacco Free Initiative (TFI), World Health Organization, Phnom Penh, Cambodia, (3) Technical Bureau, National Center for Health Promotion, Monivong Street, Phnom Penh, Cambodia, (4) Epidemiology and BioStatistics, Loma Linda University School of Public Health, Evans Hall Room 203, Loma Linda, CA 92350, (5) Preventive Medicine, Loma Linda University School of Medicine & School of Public Health, Nichol Hall Room 1516, Yucaipa, CA 92399

Objective: The Tobacco Control Leadership Training (TCLT) Survey is the largest nationwide survey of tobacco and health among Cambodian adults to be conducted to date. This survey of 13,988 adults (ages 18 and older) measured tobacco use, demographics, knowledge and attitudes about tobacco use, anthropometrics, diet, health, reproductive history, and exposure to anti-tobacco media. The findings of this survey will help guide national and regional tobacco control programs and policies.

Methods: TCLT investigators conducted a multistage stratified cluster survey of 13,988 adults selected from all provinces using the 1998 census as a sampling frame. Survey items were designed by 1) focus groups conducted in rural and urban centers 2) graduate-level training in survey research of Ministry of Health personnel that involved their selection and modification of items from tobacco use surveys of other nations (i.e. China) 3) consultation with local NGO's who had conducted provincial surveys on tobacco use.

Results: Validation analysis indicated excellent sensitivity (86%), specificity (94%), and positive predictive value (93%) in the detection of tobacco use measured by cotinine levels. Reliability analysis showed excellent re-test results for the current smoking (kappa=0.93), chewing tobacco(kappa=0.86), and current pipe use(kappa=1). Findings from the focus groups identified strong gender-related differences in reasons for starting to smoke and smoke-free areas. These data gave rise to gender-specific survey items. Preliminary analysis of the national survey data indicated that 43% of Cambodian adults were current users of tobacco. The survey showed strong demographic, regional, and behavioral trends in tobacco use in Cambodia.