Smoking addiction is a major public health problem as it is responsible for about five million deaths a year, one-third of which occurs in developing countries [1] [2] . While its harmful effects on health have been known for more than half a century, it is clear that tobacco consumption continues to increase worldwide [3] .

According to the World Health Organization (WHO), the annual death toll from 2020 to 2030 will reach ten million, 70% of which would come from developing countries. Studies [4] [5] have shown that 90% of people who die as a result of tobacco consumption started smoking before the age of 18.

However, despite the overall increase in tobacco consumption, it should be noted that the trend in developed countries is decreasing while in developing countries, the tobacco epidemic remains galloping. One out of five teenagers between the ages of 13 and 15 are smokes in developing countries [3] .

Cote d’Ivoire does not escape this scourge. Teenagers make up a large segment of the Ivorian population among who is a large proportion of smokers [2] [3] . The socio-political crisis that the country experienced from 2002 to 2010, with the consequent disruption of the socio-economic fabric, contributed to a surge in the phenomenon of “street children” [4] [5] ; children among whom they are teenagers, abandoned to their fate and were exposed to all vices including smoking addiction. In addition, many tobacco control interventions are aimed at teenagers, without taking into account their specificity.

In order to contribute to the fight against smoking addiction, it seemed appropriate to carry out this study within this segment of the population with the objectives of describing the socio-demographic profile of teenager addicted to smoking and to identify the factors that favor smoking addiction or factors associated with smoking addiction in these teenagers.

The overall prevalence of smoking in our study of 21% is comparable to the national prevalence of 22% [3] . The majority of teenagers practiced religion; this is an asset. Worship places would be strategic places to initiate training times and inform the faithful about tobacco. Religious leaders could serve as a relay for health professionals to convey messages of awareness (prevention or stopping of smoking addiction). Indeed, in Africa especially, these are respected and valued by members of the community. The use of worship places as a place of sensitization of the populations proved its effectiveness in Cote d’Ivoire in the field of vaccination [6] .

The prevalence of school smoking was 18.1%. In 2001 and 2003, previous studies in schools in Abidjan found prevalence of 14.1% and 15.9%, respectively [7] [8] . These different works show an increase in the prevalence of smoking. In Burkina Faso, Drabo et al. concluded that cigarette smoking was the most common form of smoking among middle and high school [9] students. These different works show an increase in smoking addiction [10] . According to some authors, smoking is a means of socialization for teenagers [11] . Anti-smoking programs should be revised and strengthened to better understand this socialization strategy used by teenagers.

The age of initiation of smoking corroborates data from the literature, in developed countries [10] [11] and even in developing countries [12] . However, taking into account previous Ivorian studies, it is earlier. Indeed, authors in 2003 and 2007 obtained an average age of initiation of 16 years [13] [14] . This situation would be due to the decline in the age of entry to high school which is increasingly in the early puberty period when the teenager presents risky behavior in his quest to assert his personality and to identify himself to a group of friends. In view of the foregoing the strongest actions in the fight against smoking among teenagers would be those relating to the prevention from initiation. These actions should focus on children in pre-adolescence through socio-educational activities [15] .

The majority of teenagers were male, had non-educated parents, and were in family with more than five children. A significant proportion came from a single-parent home. These socio-demographic factors listed above influenced the social status of the teenagers interviewed. In fact, the differences observed between the two groups of teenagers were statistically significant. The proportions of boys, non-educated parents, large families and single-parent families were higher in teenagers not attending school and living in the street or street children. Smoking in the girl is a real fact, but culturally little accepted by Africans [9] . These social characteristics in favor of street children are the result of the socio-political instability that the country experienced about 15 years ago.

In our study, current or recent smoking addiction was influenced by one parent’s tobacco consumption. He describes in the literature that three factors influence smoking initiation: personal vulnerability, social pressure and access to substance [9] . It is in this way that the tobacco industry is able to transform pre-smokers into apprentices and apprentices into smokers [16] . In Burkina Faso, the inefficiency of the measures applied to regulate the sale of tobacco derivatives and the protection of consumers was criticized [9] . Some authors noted that peer smoking was the best predictor of smoking among youth [15] . Finally, it is undeniable that in a context of disruption of the social fabric of ours, the management by a single parent of a large family alters the quality of education given to children, disrupts the financial stability of the household and the psychic balance of children, especially adolescents, the ability to make decisions independently is difficult [8] [13] .

Apart from smoking, we noted other addictions: drug and alcohol use.

The analysis of the classification according to the social status shows that tobacco and drugs were the privilege of teenagers not attending school and living in the street. This phenomenon is less in teenage students, this, being attributable to the double control they are undergoing; that of parents and that of school educators [15] . As for alcohol consumption, it was similar in both groups. This substance is sold in all forms of representation from the glass bottle to the single dose plastic package, and the prices are affordable for everyone.

The influence of the circle, especially, parents smoking addiction is a factor that should not be overlooked. Parents represent models to imitate. The incentive to smoke is then exerted permanently and repeatedly on the teenager when the parent tends to smoke at home. The children of parents smokers would consider the first cigarettes a little like an initiation rite allowing them to leave the world of childhood to access that of adulthood [17] . Children of parent smokers would consider the first cigarettes a bit like an initiation ritual allowing them to leave the world of childhood to reach that of adulthood [17] . In addition, the negative consequences on the state of health of the circle of passive smoking addiction, which is also a real scourge, should not be overlooked [14] [17] . In Togo, Hatta O et al. have demonstrated that prosocial behaviors mediate between psychological difficulties and substance use [16] .

The main reasons for the consumption of tobacco in teenagers by order of frequency were imitation, curiosity and the desire of self-assertiveness. These reasons are in line with the adolescence features marked by a transitory psychic derangement where the teenager shows oppositional behaviors towards parents and peer group identification behaviors [17] [18] . In North Africa, the same reasons are raised [10] [19] . In France, however, other reasons were raised: stress, boredom and the improvement of intellectual concentration. Any coming off proposal should take into account these motivations and help to clarify the needs of teenagers [18] [20] .

Teenagers not attending school and living in the streets or street children were more affected by smoking addiction. However, in schools the prevalence of smoking addiction gradually increases. The age of smoking initiation is early. The reasons for tobacco addiction are imitation, curiosity and desire of self-assertiveness.

To overcome the problem of smoking addiction in teenagers, it would be necessary firstly to strengthen school and university health services (SSSU) as part of support in school and secondly to provide health care services adapted to teenagers. It would also be necessary to strengthen tobacco control strategies taking into account the psychosocial characteristics of teenagers. To this end, coordinated multi-sectoral actions involving the family unit, social and health workers, educators, sociologists and psychologists should be considered by the National Program for the Fight against Tobacco in Côte d’Ivoire.

The authors declare no conflicts of interest regarding the publication of this paper.

Marie-Hélène, A.-A., Amed, C., François, E.T., Armel, B.K. and Alexandre, B.K. (2018) Smoking Addiction and Risk Factors in Teenagers in Abidjan, Cote d’Ivoire. Open Journal of Pediatrics, 8, 293-302. https://doi.org/10.4236/ojped.2018.84030