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Table of Contents
ORIGINAL ARTICLE
Year : 2017  |  Volume : 5  |  Issue : 1  |  Page : 32-38

Prevalence and correlates of tobacco use among school going adolescents in a rural area of Himachal Pradesh, India


1 Assistant Professor, Department of Community Medicine, Maharishi Markandeshwar Medical College & Hospital, Solan, Himachal Pradesh, India
2 Final Year MBBS student, Maharishi Markandeshwar Medical College & Hospital, Solan, Himachal Pradesh, India
3 Public Health Specialist, Department of Health and Family Welfare, Solan, Himachal Pradesh, India
4 Professor, Department of Community Medicine, Maharishi Markandeshwar Medical College & Hospital, Solan, Himachal Pradesh, India

Date of Web Publication30-Aug-2018

Correspondence Address:
Bharti Chawla
Assistant Professor, Department of Community Medicine, Maharishi Markandeshwar Medical College & Hospital, Solan, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-6486.240222

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  Abstract 


Background: Tobacco use usually starts in adolescence and continues into adult life, meaning that many future victims of tobacco use are today’s children. To counteract the effect various tobacco control strategies in India, as in the rest of the developing world, there is an urgent need for good, scientifically sound data about tobacco use patterns that would allow cross-country and within-country comparisons. This study was conducted to find out the prevalence & correlates of tobacco use among school going adolescents in a rural area of Himachal Pradesh, India
Methodology: This was a cross sectional study from 4 co-educational schools of district Solan , Himachal Pradesh. There were 200 students enrolled for the study. The ethics committee clearance was taken from IEC. Appropriate statistical tests were applied.
Results: The prevalence of current and ever tobacco use among school going adolescents in our present study was found out to be 4.5% and 2.0% respectively. Class wise ever tobacco users were more in classes 9th (6.6%) and 10th (5.7). Gender wise males had higher prevalence of current tobacco use (8.1%) than females (1.1%), which was statistically significant (p =0.024).
Conclusion: The present study suggests the need for school-based tobacco prevention programs. It is better to prevent the initiation of the habit than trying to stop the habit, highlighting the role of primordial prevention. Enforcement of regulations on sale of tobacco products may also be useful.

Keywords: Tobacco, Adolescents, Prevalence, Correlates


How to cite this article:
Chawla S, Chawla B, Bhardwaj N, Singh AK, Aggarwal SK. Prevalence and correlates of tobacco use among school going adolescents in a rural area of Himachal Pradesh, India. J Integr Health Sci 2017;5:32-8

How to cite this URL:
Chawla S, Chawla B, Bhardwaj N, Singh AK, Aggarwal SK. Prevalence and correlates of tobacco use among school going adolescents in a rural area of Himachal Pradesh, India. J Integr Health Sci [serial online] 2017 [cited 2023 Feb 5];5:32-8. Available from: https://www.jihs.in/text.asp?2017/5/1/32/240222




  Introduction Top


Tobacco consumption is accounted as a prominent worldwide health problem. It poses as a greater threat with reason being there is a considerable amount of time lag between initial consumption and occurrence of first symptoms. Tobacco caused 100 million deaths in the 20th century. If current trends continue, it will cause up to one billion deaths in the 21st century. Unchecked, tobacco-related deaths will increase to more than eight million per year by 2030. It kills nearly six million people a year, of whom more than 5 million are users and ex users and more than 600,000 are non smokers exposed to second-hand smoke.[1]

Globally, cigarette smoking is the dominant form of tobacco use. Tobacco is consumed in a variety of ways ; broadly in smoke and smokeless forms, e.g. bidi, gutkha, khaini, paan masala, hookah, cigarettes, cigars, chutta, gul, mawa, misri, etc. Tobacco is also a part of the socio-cultural mileau in various societies, especially in the Eastern, Northern, and North-Eastern parts of the country.[2]

Tobacco use usually starts in adolescence and continues into adult life, meaning that many future victims of tobacco use are today’s children. Adolescents and young adults of colleges are often targeted by the tobacco industry for marketing. Research has shown that teen tobacco users are more likely to use alcohol and illegal drugs than are non-users. The risks of tobacco use are highest among those who start early and continue its use for a long period.[3]

The studies about tobacco use and its correlates like awareness, knowledge etc. among school students in the need of the hour. These factors may be specific to culture, traditions and other characteristics of the area. Identification of such factors may be potentially useful to formulate policy interventions needed towards Behavior Change Communication (BCC) for prevention and control of tobacco use among school students.

In this era of globalization, youth and adolescents are adopting behavior patterns that are comparable from country to country. Tobacco companies are taking advantage of this situation. They are advertising tobacco products using mass media techniques targeting “the adolescents of the world”. To counteract the effect of this strategy in India, as in the rest of the developing world, there is an urgent need for good, scientifically sound data about tobacco use patterns that would allow cross-country and within-country comparisons. This study was conducted to find out the prevalence & correlates of tobacco use among school going adolescents in a rural area of Himachal Pradesh, India.


  Methodology Top


Study Design

A cross-sectional study

Study Area

The study was carried out in all four co-educational schools (2 Govt. & 2 Private) served under area of Primary health centre Sultanpur, District Solan, H.P.

Sample Size

Considering prevalence of tobacco use among adolescents as 33%[4] and allowable error of 20%, at level of significance of 95%, and using the standard formula for calculating the sample size:

N= 4PQ/L2, where N is the sample size to be taken, P is the 33%, Q= 1-prevalence, L= Relative allowable error Type 1 error=5%, Power =80%.

Putting all these values in the above formula gives a desirable sample size of 200.

Study Population

The students of 7th to 10 th class were included in the study.

Exclusion Criteria:

  1. Those who were not willing to participate in the study.
  2. Subjects who could not be contacted on three consecutive visits


Study tool

A pre-designed, pretested and semi-structured interview schedule

Study period

The study was conducted over 2 month’s period i.e. August to September 2016

Data Collection and Analysis

The study area is served by 2 Govt. & 2 Private high schools. The list of students studying in 7th to 10th grades in these schools was obtained from respective authorities of institution. 50 students were selected from each chosen school (total 4 schools 50x4=200) from the obtained list of students by simple random sampling. A total of 200 students were included in the study. The objective and nature of the study was explained to the principal of each selected school and a verbal consent was sought to carry out the survey in the schools. All the eligible students present at the time of visit were included for the survey and those, absent, were excluded. The students of the selected classes were assembled in their class room. The purpose of the survey was explained and assurance, about the confidentiality of the information, was given to the students and each student was free to participate or not in the survey. Absence of the school personnel in the classrooms was ensured to encourage the students to eliminate bias. Ethical approval was taken from Institutional Ethics Committee.

Collected data was entered in the MS Excel spread sheet, coded appropriately and later cleaned for any possible errors. Analysis was carried out using SPSS (Statistical Package for Social Studies) for Windows version 21.0 and online Graph Pad software (Prism 5 for Windows) version 5.01. During data cleaning, more variables were created so as to facilitate association of variables. Clear values for various outcomes were determined before running frequency tests.

Pearson”s chi square test was used to evaluate differences between groups for categorized variables. Normally distributed data was presented as means and standard deviation, or 95%confidence intervals (CI). All tests was performed at a 5% level of significance, thus an association was significant if the p value was less than 0.05.

Definitions of the Variables

Ever users -Anyone who had used tobacco even once in any form at any point in a lifetime.
Table 1: Socio- demographic characteristics of study subjects (N=200)

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  Results Top


The present study involved 200 subjects and found that more than half of the study subjects (62%) were in age group 14-15 years, followed by 37% in 10-13 and 2% in 16-19 years age group. Out of total subjects, 55.5% were males and 45.5% were females. Majority of subjects belonged to the general caste (86.5%). More than half (67.5%) of subjects lived in nuclear families while the rest lived in joint families.

[Table 2] shows that the prevalence of current and ever tobacco use among school going adolescents in our present study was found out to be 4.5% and 2.0% respectively.
Table 2: Prevalence of current and ever tobacco use among study subjects (N=200)

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[Table 3] depicts that total prevalence of current tobacco use was 2%. It was higher in males (2.7%) than females (1.1%). Ever tobacco use was found to be more in nuclear (2.2%) than joint (1.5%) families. According to caste, maximum prevalence was found in scheduled caste (7.7%) while it was lesser (1.1%) in general caste. Only caste wise prevalence of ever tobacco use was found to be statistically significant (p = 0.000) among all the mentioned variables.
Table 3: Characteristic wise prevalence of current tobacco use among study subjects (N=200)

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[Table 4] depicts the prevalence of ever tobacco use among study subjects according to various characteristics. The total prevalence of current tobacco use among study subjects was 4.5%.
Table 4: Characteristic wise prevalence of ever tobacco use among study subjects

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Class wise ever tobacco users were more in classes 9th (6.6%) and 10th (5.7). Gender wise males had higher prevalence of current tobacco use (8.1%) than females (1.1%), which was statistically significant (p =0.024). Also caste wise prevalence of current tobacco user was found to be not significant. Students living in joint families (6.1%) had significantly higher prevalence of current tobacco use than those living in joint families (3.7%).

The [Table 5] depicts that most of the ever tobacco users said that they used tobacco under the influence of curiosity (75%) followed by peer group/friends (50%), enjoyment (25%), movies (25%) and celebrities (25%). Curiosity (66.6%) among male ever users and among female counterparts was the major influencing factor for ever tobacco use.
Table 5: Gender wise influencing factors among ever and current tobacco users (N=200)

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The most of the current tobacco users used tobacco due to peer group/friends (66.7%) followed by curiosity (44.4%), enjoyment (33%) and celebrities (22%) [Table 5].

Peer group/friends (62.5%) among male current tobacco users were the major influencing factors for tobacco use.


  Discussion Top


The purpose of the study was to estimate the prevalence of tobacco use and assess the correlate factors. The sample size was determined using data from GYTS[5], Himachal Pradesh 2004 and obtained a representative sample from the area. In our study, the prevalence of ever tobacco use and current tobacco use was 2% and 4.5% respectively.

According to GYTS Himachal Pradesh 2003, the prevalence of ever tobacco use was found to be 4 % with 4.3% in boys and 3.7% in girls.10 GYTS India 2006 and GYTS India 2009 reported the prevalence of ever tobacco use as 14.4% in boys; 8.7% in girls and 19.0% in boys; 8.3% in girls respectively which clearly showed higher prevalence among boys as compared to girls which is in coherence with the present study[5].

The higher prevalence may be due to the higher level of exposure, social and financial independence among boys regarding their individual behavior than girls, both in the family as well as in the society. Also similar to present study, multivariate analysis showed that tobacco use was associated with late adolescence (OR: 1.64; 95% CI 1.17 to 2.28), male gender (OR: 12.20; 95% CI 7.78 to 19.14) in a study by Pradhan et al in Nepal.[6] However Sinha et al in his study in Bihar found very high prevalence of ever tobacco use (71.8%) among school going adolescents with 76.5% in boys and 57.2% in girls.[7]

Another study was carried out among male adolescents by Awasthi et al., in Uttar Pradesh and observed that the prevalence of ever tobacco use was 35.7%.[8] High prevalence of tobacco use among students in Bihar and Uttar Pradesh can be attributed to their socio-cultural pattern and high rates of tobacco use in the society. When prevalence was compared to the studies of other Asian countries, it was reported to be 19.7% ever tobacco user (33.6% boys; 4% girls) in study conducted in Nepal by Pradhan et al[6] 42.9% males and 18.4% ever smoker in study conducted in Thailand by Rudatsikira et al;[9] 32% ever smokers in Indonesia by Martini et al.16 Low prevalence in our study may be attributed to the increase in awareness about tobacco related dangers among general population and study subjects, vigorous anti tobacco campaigning, and efforts to implement[7] for comprehensive ban on TAPS (Tobacco advertising, promotion and sponsorship) by WHO FCTC.

The total prevalence of current tobacco use among study subjects in the present study was found to be 2%. The present study reported that students living in joint families (1.5%) had lower prevalence of current tobacco use (p = 0. 000) than those living in nuclear families (2.2%) . According to GYTS Himachal Pradesh 2003, prevalence of current tobacco use was found to be %.4 Also GYTS India 2006 and GYTS India 2009 reported that the prevalence of current tobacco use was 13.7% and 14.6% respectively which is much higher than prevalence of current tobacco use (3.3%) in our study.[5] A study undertaken by Sinha et al in Bihar also revealed very high prevalence of current tobacco use (58.9%) among adolescents which can be ascribed to the different socio-cultural pattern across the states and within states in India.[7]

In the present study, the prevalence of current tobacco use was higher among males (8.1%) study subjects as comparison to female (1.1%) subjects which was statistically significant (p = ) .

Similar finding was reported by GYTS Himachal Pradesh 2003 (3.5% boys; 1.6% girls)[10], GYTS India 2006 (16.8% boys; 9.4% girls), GYTS India 2009 (19.0% boys; 8.3% girls)[5] and the same observation (23% male; 17% female) was reported by one of the international study conducted by Martini et al (2005) in Indonesia.[10] Also, the prevalence of current tobacco use amongst study subjects was almost twice in joint family (6.1%) as compared to nuclear family (3.7%). Current tobacco use was appreciably higher among the males than the female respondents as discussed in above studies. This finding is in coherence with present study which may be attributed to socio-cultural practices, higher exposure, acceptance and independence among boys both in family as well as society.


  Limitations of Study Top


  1. As the present study was conducted among students of 7th to 10th class, the late adolescence age group might not have been adequately represented.
  2. This study was a cross-sectional study, detailed analysis of influencing factors for adolescent tobacco use was limited.



  Conclusion Top


The present study suggests the need for school- based tobacco prevention programs and it is better to prevent the initiation of the habit than trying to stop the habit, highlighting the role of primordial prevention. Enforcement of regulations on sale of tobacco products may also be useful. Strengthening of legislations on the use of tobacco products may lead to decrease availability, accessibility and affordability of tobacco products to these age groups. Although several government policies are made in India, these need to be made stringent in schools and colleges.



 
  References Top

1.
World Health Organization. Media centre. Geneva: WHO; 2012. [cited 2012 May 30]; Available from: URL: http://www.who.int/mediacentre/factsheets/fs/339/en/index/html  Back to cited text no. 1
    
2.
Reddy KS, Gupta PC. Report on Tobacco Control in India. Ministry of Health and Family Welfare, NirmanBhavan, Government of India, New Delhi 2004.  Back to cited text no. 2
    
3.
Sagarkar AR, Sagarkar RM, Arabbi KC, Shivamallappa SM. A substantive review on tobacco use among school-going adolescents in India. Journal of International Society of Preventive & Community Dentistry. 2013 Jan;3(1):7-11.  Back to cited text no. 3
    
4.
Makwana NR, Shah VR, Yadav S. A study on prevalence of smoking and tobacco chewing among adolescents in rural areas of Jamnagar district, Gujarat state. JMSR. 2007 Sep 30;1(1):47-50.  Back to cited text no. 4
    
5.
Ministry of health and family welfare. Findings from the Global Youth Tobacco Survey (GYTS) and Global School Personnel Survey (GSPS) India 2003-2009. New Delhi: Ministry of health and family welfare, Government of India; 2009.  Back to cited text no. 5
    
6.
Pradhan PM, Niraula SR, Ghimire A, Singh SB, Pokharel PK. Tobacco use and associated factors among adolescent students in Dharan, Eastern Nepal: a cross-sectional questionnaire survey. BMJ open. 2013 Jan 1;3(2):e002123.  Back to cited text no. 6
    
7.
Sinha DN, Gupta PC, Pednekar M. Tobacco use among students in Bihar (India). Indian journal of public health. 2004 Jul 1;48(3):111- 7.  Back to cited text no. 7
    
8.
Awasthi S, Jha SK, Rawat CM, Pandey S, Swami SS. Correlates of tobacco use among male adolescents in schools of Haldwani, Nainital. Health and Population: Perspectives and Issues. 2010 Jan;33(1):42-9.  Back to cited text no. 8
    
9.
Rudatsikira E, Muula AS, Siziya S, Mataya RH. Correlates of cigarette smoking among school-going adolescents in Thailand: findings from the Thai global youth tobacco survey 2005. International Archives of Medicine. 2008 Jun 11;1(1):8.  Back to cited text no. 9
    
10.
Martini S, Sulistyowatib M. The Determinants of Smoking Behavior among Teenagers in East Java Province, Indonesia. NW Washington: The World Bank; 2005.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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  In this article
Abstract
Introduction
Methodology
Results
Discussion
Limitations of Study
Conclusion
References
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