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Open Access March 11, 2025

Why High Income Fails to Reduce E-Cigarette Use: The Knowledge-Attitude Paradox in the SMOKES Study

Abstract Background: Electronic cigarette (e-cigarette) use and vaping tobacco have increased rapidly worldwide, raising concerns about their health effects, social acceptability, and regulatory challenges. In many countries, e-cigarettes are more commonly used by individuals from higher socioeconomic status (SES) backgrounds, who, in theory, should have greater knowledge about e-cigarettes and [...] Read more.
Background: Electronic cigarette (e-cigarette) use and vaping tobacco have increased rapidly worldwide, raising concerns about their health effects, social acceptability, and regulatory challenges. In many countries, e-cigarettes are more commonly used by individuals from higher socioeconomic status (SES) backgrounds, who, in theory, should have greater knowledge about e-cigarettes and their associated risks. However, it remains unclear why a group with more knowledge about e-cigarette risks would also hold more positive attitudes toward vaping and exhibit higher usage rates — a phenomenon that may represent a knowledge-behavior paradox. Understanding this paradox, along with the complex relationships between e-cigarette knowledge, attitudes, and behaviors, is critical for informing effective public health interventions, campaigns, social media messaging, and regulatory policies. Objectives: This study aimed to evaluate the complex relationship between SES, e-cigarette knowledge, pro-vaping attitudes, and e-cigarette use. Methods: The SMOKES Study (Study of Measurement of Knowledge and Examination of Support for Tobacco Control Policies) used a multi-center, cross-sectional design, collecting data from 2,403 college and university students across 15 provinces in Iran (covering nearly half of the country's provinces). The survey measured family income, age, sex, ethnicity, e-cigarette use, knowledge, and attitudes. Structural Equation Modeling (SEM) was employed to examine the interrelations between SES, knowledge, attitudes, and behavior, while adjusting for age, sex, and ethnic minority status. Results: SEM analysis confirmed the hypothesized paradox. Although greater knowledge about e-cigarettes was linked to less favorable attitudes toward vaping and lower use, pro-vaping attitudes emerged as the strongest predictor of vaping behavior, while knowledge played a weaker protective role. Notably, individuals with higher SES simultaneously showed higher knowledge and, paradoxically, more pro-e-cigarette attitudes and greater usage. Female students and ethnic minority students reported higher correct knowledge and lower pro-vaping attitudes and use. Although age and higher family income were associated with more favorable attitudes, they did not directly predict vaping behavior. These results suggest that for higher SES individuals, poor knowledge is not the main driver of e-cigarette use; rather, their pro-e-cigarette attitudes, which seem to outweigh the influence of knowledge, play a key role. Conclusions: Although individuals from higher SES backgrounds report greater correct knowledge about e-cigarettes, this knowledge does not necessarily translate into reduced positive attitudes or lower usage. This study highlights the complexity of these paradoxical effects and suggests that public health strategies need to go beyond simple education and knowledge-based interventions. Targeted approaches should address industry messaging, challenge misconceptions, and strengthen regulatory efforts to reduce e-cigarette use among young adults, including those from higher SES backgrounds.
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Open Access September 22, 2024

An Appraisal of Paragraph Unity and Coherence in Writing

Abstract Good academic writing requires a good combination of cohesive ties and coherent features in the text. This study aimed to assess whether paragraph unity and coherence in writing were achieved among students of the Komenda College of Education concerning gender. Lakoff’s Theory underpinned the study. The quantitative approach and a descriptive research design were used in the study. The sample size [...] Read more.
Good academic writing requires a good combination of cohesive ties and coherent features in the text. This study aimed to assess whether paragraph unity and coherence in writing were achieved among students of the Komenda College of Education concerning gender. Lakoff’s Theory underpinned the study. The quantitative approach and a descriptive research design were used in the study. The sample size was 60 (40 males and 20 females). Level 200 students from the Komenda College of Education Department of English were selected using census techniques. The instruments used for data collection were text items and questionnaires. Paragraphs written by the students were analysed using narratives, and quantitative data was analysed using mean, standard deviation and the independent samples t-test. The study revealed that male students have a higher mean score than female students. The study also concluded that there was no significant difference between male and female students regarding achieving paragraph unity and coherence in writing. In other words, gender does not influence how paragraph unity and coherence are achieved in writing – males and females are statistically the same. It is recommended that the principals of the various colleges of education in Ghana encourage the college tutors and the Student Representative Council (SRC) leadership to introduce a programme which engages college students in competitive writing without gender barriers. This programme will ensure that students compete by writing academic papers, demonstrating their knowledge of achieving unity and coherence in writing. This programme can be done every academic year, and an equal number of males and females are presented yearly.
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Open Access October 05, 2022

An Assessment into Parental Factors that Motivate Female Students to Complete Formal Education

Abstract Qualitatively the study adopted a case study research design to examine the parental factors that motivate female students to complete formal education in Tolon District. The population for this study comprised of all females in the Tolon District who have successfully completed formal education. A purposive sampling technique was used to select ten (10) females who have successfully completed [...] Read more.
Qualitatively the study adopted a case study research design to examine the parental factors that motivate female students to complete formal education in Tolon District. The population for this study comprised of all females in the Tolon District who have successfully completed formal education. A purposive sampling technique was used to select ten (10) females who have successfully completed formal education and are now working in the Tolon District. The main instrument used for data collection was interview. Data were analysed by the use of the Interpretive Method based on the themes arrived at during the data collection. The themes were related to the research question and interpreted on the number of issues raised by respondents. The study revealed that, financial support of parents was vital to enrolment, sustenance and ultimate completion of the education of females. The study also indicated that parents give support in the form of guidance and counseling as well as moral support through encouragement of the Girl-Child played a key role to their successful education. It is recommended that, parents still need more advocacies on the importance of educating the girl child in order to enhance their interest in sending or motivating the girl child in school. It is also recommended that parents should discouraged early marriages to help girls to fully complete their formal education.
Article
Open Access May 22, 2022

Prevalence and predictors of physical activity among female high school students in The Gambia: an institutional-based cross-sectional study

Abstract Background: Everyone, irrespective of age, sex, colour, ethnicity, or present overall fitness level, can benefit from regular exercise. To improve one's health, one must engage in regular physical activity. People with underlying illnesses like long-term impairment can benefit from regular physical activity at the individual level, especially young women. Thus, the current study aimed to [...] Read more.
Background: Everyone, irrespective of age, sex, colour, ethnicity, or present overall fitness level, can benefit from regular exercise. To improve one's health, one must engage in regular physical activity. People with underlying illnesses like long-term impairment can benefit from regular physical activity at the individual level, especially young women. Thus, the current study aimed to assess the prevalence and determinants of physical activity among female school-aged adolescents in the West Coast Region of The Gambia. Methods: The present study used an institutional-based cross-sectional analytical study to collect quantitative data from 384 female high school students in The Gambia. The study used a content-validated, pretested structured questionnaire that consisted of both open and closed-ended questions on physical activity. The data were processed and analyzed using IBM SPSS version 26.0. Descriptive statistics and Chi-square and/or Fisher exact test were used with a p-value <0.15 for inclusion in the logistic regression model. Adjusted odds ratios (aORs) and 95% confidence intervals were calculated, while p-value <0.05 was considered for statistical significance. Results: The proportion of female students involved in physical activity was 37.5%. The mean age of students was 18.8 years with a standard deviation of 1.7 years. Factors such as female students between 17 – 20 years (aOR:3.05, 95% C.I. (1.807 – 5.138)), father never been to school (aOR: 2.82, 95% C.I. (1.495 – 5.334)), primary education (aOR: 2.15, 95% C.I. (1.027 – 4.493)), upper basic school (aOR: 2.31, 95% C.I. (1.055 – 5.074)) and science major students (aOR: 2.21, 95% C.I. (1.203 – 4.047)) had increased odds of involving in PA. Furthermore, students who knew that exercise would strengthen bones (aOR: 2.62, 95% C.I (1.444 – 4.739)), do a planned brisk walking (aOR: 19.16, 95% C.I. (6.698 – 54.811)), basketball/football (aOR: 29.76, 95% C.I. (10.004 – 88.512)) and skipping with rope (aOR: 29.15, 95% C.I. (9.726 – 87.333)) had increased odds to involved in PA after controlling for confounders. Other factors such as students whose mother never been to school (aOR: 0.31, 95% C.I. (0.140 – 0.674)), primary level (aOR: 0.25, 95% C.I. (0.123 – 0.518)), senior secondary level (aOR: 0.42, 95% C.I. (0.189 – 0.935)), nuclear family (aOR: 0.23, 95% C.I. (0.119 – 0.458)) and extended family (aOR: 0.45, 95% C.I. (0.225 – 0.915)) had reduced odds of involving in PA. Conclusion: There is low physical activity among female adolescents in schools. For this, it is imperative that suitable interventions be implemented to raise the level of physical activity among secondary school students. A future intervention for school-aged adolescents could benefit from these findings.
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