Tobacco use among high school children in Bangalore, India: A study of knowledge, attitude and practice

Tobacco use and oral health related quality of life among Indian adolescents

OBJECTIVES

The present study was conducted to assess tobacco use and its effect on Oral Health-Related Quality of Life (OHRQoL) in Indian adolescents.

METHODS

The present study was conducted on 1,600 13-14 year old adolescents from the schools of Modinagar, western Uttar Pradesh, India selected using stratified random sampling technique. OHRQoL was assessed using Hindi version of Child Perceptions Questionnaire (CPQ). Information regarding demographic, socioeconomic and oral health measures was also collected from the study participants. Tobacco use was assessed through questions derived from Global Youth Tobacco Survey (GYTS) questionnaire. Influence of predictor variables on tobacco use was evaluated using multilevel Poisson regression model.

RESULTS

The tobacco use among the study population was 8.1 % and CPQ scores were 9.15±0.32. Adolescents who used tobacco had worse OHRQoL scores. Low socioeconomic status, presence of dental caries, absence of regular dental visits (last 6 months) were associated with increased regular consumption of tobacco products.

CONCLUSIONS

The findings of the present study play an important role in planning public health strategies to improve adolescent OHRQoL and reduce tobacco use.

Perception of Tobacco Use among School-Going Early Adolescent Children in Udupi District: A Cross-sectional Study

Background

Tobacco use among school-going children is a significant public health concern worldwide. Studies on perception and knowledge about harmful effects of tobacco use among early adolescent children are limited.

Aim

To assess the knowledge, attitude, and perception of tobacco use among rural and urban school-going early adolescent children.

Methods

A cross-sectional study design was used. Using mixed method multi-stage sampling, a sample of 218 eighth grade students were selected randomly using the simple random technique from two government schools (rural and urban schools were chosen purposively), Udupi district, Karnataka. Data were collected using the questionnaire method. The Global Youth Tobacco Survey was used for the data collection. Descriptive statistics were used to express the data and Chi-square test and Fisher's exact test were used to compare the categorical variables.

Results

More than one-third (39%) of middle school children have used tobacco in the past. About 44% of boys felt guilty about their tobacco use. About two percent tried using other forms of tobacco products. Less than 1% of them had used tobacco more than once in the past 30 days. Urban children had significantly more knowledge about the harmful effects of tobacco use (p = .001), quitting tobacco (χ2 = 11.6, p = .008), and reasons for quitting tobacco use was, noticing anti-tobacco messages. More urban children think using tobacco makes boys more attractive (χ2 = 9.07, p = .01) and girls more attractive (χ2 = 10.80, p = .004).

Conclusion

The prevalence of tobacco use was 1.5% among middle-school children in the last month. Urban school children have significantly more knowledge and awareness about the harmful effects of tobacco use than rural students.

Tobacco use and exposure to second-hand smoke among high school students in Ernakulum district, Kerala: A cross-sectional study

Objectives

Tobacco use and exposure to second-hand smoke (SHS) in the home setting are major health hazards for adolescents. The objectives of this study were to estimate tobacco use and exposure to SHS among high school students in Ernakulam district of Kerala, India, and to investigate associated factors.

Study design

Cross-sectional study.

Methods

A school-based cross-sectional study was carried out in 25 randomly selected high schools from 210 schools in the Ernakulam educational district of Kerala, India. The minimum calculated sample size for ever-use of tobacco and SHS exposure was determined to be 2500, with 95% confidence interval (CI) and 10% relative precision. Data were collected using a semi-structured, pre-tested questionnaire from 2585 high school students. Data analyses were performed using SPSS version 20.

Results

The ever-use of tobacco was reported to be 3.9% (95% CI 3.16 to 4.54) and the mean age of the participants was 13.97 ± 0.77 years. One-fifth of participants had tried a tobacco product before the age of 10 years. SHS exposure at home was reported by one in every 5 respondents (20.3%). Male gender (adjusted odds ratio [aOR] 8.79; 95% CI 3.16, 24.53), presence of a family member who smokes within the home (aOR 4.28; 95% CI 2.58, 7.12), lack of awareness about the harmful effects of SHS exposure (aOR 2.47; 95% CI 1.41, 5.18) and having seen an advertisement or promotion at point of sale (aOR 2.16; 95% CI 1.29, 3.60) were found to be independent predictors for tobacco use.

Participants with respiratory infections were three times more likely to have experienced SHS exposure at home (aOR 2.87; 95% CI 2.21, 3.74), there was an 86% protective effect of SHS exposure for participants with a father in a professional occupation compared with unskilled profession (aOR 0.14; 95% CI 0.02, 0.67; p < 0.15) and participants with ever-use of tobacco were two times more likely to have experienced SHS exposure at home (aOR 1.63; 95% CI 3.13, 8.98).

Conclusions

SHS exposure in the home environment continues to be high. Urgent innovative measures are necessary for the implementation of tobacco smoke-free homes and to reduce tobacco use in this vulnerable population. Further studies are necessary to determine ways to reduce smoking within homes and to increase population awareness.

•

This study estimates the ever use of tobacco among adolescents to be low at 3.5%.

•

However, alarmingly one fifth of the students continue to be exposed to secondhand smoke at home this is associated with increasing respiratory infections.

Prevalence and Social Contextual Factors of Smokeless Tobacco Use: Insights from Schools of Delhi, India

Background:

It was observed that adult users start tobacco use in childhood or adolescence. The influence of digital and print media, social acceptance among peers, and in order to mimic role models from films attracts youth towards tobacco. Hence this study was conducted to assess the prevalence of smokeless tobacco (SLT) use among school-going adolescents with the assessment of the influencing factors such as exposure at school, home, and public places along with the role of various media in SLT use by adolescents.

Methods:

Cross sectional study was conducted with 860 students of class 9^th -12^th enrolled in schools. Purposive sampling of three schools was done from the study area to reach desired sample size. All the students of class 9^th - 12^th within selected schools were given chance to participate in the study. Data collection was done using pretested modified Global Youth Tobacco Survey (GYTS) questionnaire.

Results:

Consumption of smokeless tobacco (SLT) was observed in 79 (11%) of 714 subjects. Significantly higher proportion (18.4%) of study subjects consumed SLT who were exposed to tobacco at school premises and 19.1% of study subjects who were exposed to teacher using SLT in schools compared to non-exposed group. (p=0.016). It was observed that 8.1% of subjects without any exposure to tobacco at home and 9.8% of subjects without exposure to tobacco at outdoor public space consumed SLT. Consumption of SLT use was highest (16.7%) among subjects exposed to tobacco advertisement or promotion through social media (p=0.04).

Conclusion:

High prevalence of SLT was detected among adolescents in school. Factors such as exposure to tobacco at home, public places, school and school teacher using SLT, exposure of tobacco advertisement and promotion via different modes of media was found to be significantly associated with the use of SLT in the adolescents of school.

Why do Adolescents Initiate and Continue Using Tobacco and Areca Nut?: A Qualitative Study Tracing Pathways of Use Among School-Going Adolescents in Mumbai, India

BACKGROUND

Tobacco and areca-nut use among adolescents has been reported from different parts of India. Multiple factors influence initiation of tobacco use among adolescents. Initiation of one product gradually extends to multiple products. Studies on initiation lack documentation of the pathways and experiences post-initiation, which is required to holistically understand behavior patterns of adolescents for planning timely intervention. This study was conducted to trace pathways and identify factors influencing the initiation and continuation of tobacco and areca-nut among adolescents.

METHODS

In this two-staged study, we conducted 14 focus group discussions (FGDs) with 166 adolescents studying in grades 7-9 (11-18 years) from six municipal schools in Mumbai, India. They had self-reported areca-nut or smoked or smokeless tobacco (SLT) use. Pathways of initiation were traced through in-depth interviews for 60 adolescents.

RESULTS

Four multi-linear pathways of use were identified: (1) areca-nut only, (2) areca-nut to tobacco, (3) initiation with SLT, and (4) initiation with smoking. Raw or sweetened areca-nut, betel leaf, gutka, masheri, mawa, hookah, cigarette, bidi, and e-cigarettes were products reported to be used. Curiosity, easy access to tobacco products and normalization of tobacco use influenced initiation. Areca-nut acted as a precursor to tobacco use.

CONCLUSION

Tracing pathways in tobacco use helped to understand reasons for initiation, influences in continuation of use, and experiences of significance to the adolescents. Experiences of adolescents play a critical role in shaping the pathways of tobacco use. Understanding the pathways and influencers will further help to build effective health promotion communication, policies for sale to minors, and school-based cessation interventions.

IMPLICATIONS

Findings of the study provide an insight into unknown areas of information regarding products used by adolescents, their patterns of consumption, perceptions, and their pathways of initiation and continuation of primary and secondary products. This will help in developing specific public health awareness messages, policies regarding packaging and sale of areca-nut to children and interventions targeted for the adolescents and their specific products of use not just in India but for the South-East Asia region as areca-nut and tobacco use among adolescents is common in the region. The exercise of tracing the pathways provides basis for cessation counseling among adolescents.

Prevalence patterns and profile of adolescent tobacco users findings from a youth survey: A cross-sectional study

AIM

To assess the prevalence of smoking and smokeless tobacco use among 16--19-year-old government and private college student of Bhubaneswar city.

MATERIALS AND METHODS

A cross-sectional descriptive study was designed and data on tobacco usage was collected from 906 students aged 16--19-year old government and private college students of Bhubaneswar city using modified youth tobacco survey (YTS) closed-ended questionnaire. Data was analyzed using descriptive statistics and Chi-square tests were used to determine the significant differences in the variables of interest.

RESULTS

Out of 906 study subjects, mean age of initiation of use of tobacco product was found to be 14.8 among males and 15.3 among females. The responses of study subjects upon there believe that tobacco companies try to lure young people to use tobacco products, 54.7% males, 45.3% females reported as yes. 63 (9.9%) of students from private college reported using smokeless tobacco whereas 27 (10%) of students from government college used chewing tobacco. The results were statistically significant. A total of 84 (16.9%) males followed by 18 (4.4%) females reported to have ever tried smoking. The results were statistically significant.

CONCLUSION

It was encouraging to find that during the period of the survey, majority of students did not use tobacco of any form. Regular and systematic education programs catering to teachers, children, and also their parents should be undertaken. Enabling teachers to educate the young impressionable minds regarding lifestyle disorders should be a cornerstone activity in preventing the establishment of lifestyle disorders like tobacco and alcohol use within the community.

Knowledge about and sources of smoking-related knowledge, and influencing factors among male urban secondary school students in Chongqing, China

Objectives

This study examined smoking-related knowledge, sources of smoking-related knowledge and its influencing factor among male urban secondary school students.

Methods

We conducted a cross-sectional survey, using a self-administered questionnaire, among 1297 male secondary school students in municipal areas of Chongqing, China.

Results

Non-smokers had a better knowledge of smoking hazards than smokers. Less than 20% of students knew that smoking can cause heart disease, peptic ulcer, and cerebral stroke. Sources of smoking-related knowledge differed between smokers and non-smokers, respectively: TV (76.5 vs. 76.7%), teacher (70.1 vs. 62.4%), social network (66.6 vs. 73.1%), parents (57.0 vs. 59.2%), newspaper (55.4 vs. 61.6%), and friends (37.7 vs. 33.9%). Non-smokers’ hobbies of reading were significantly higher than smokers’ (χ² = 11.5845, p = 0.0007). Smokers’ hobbies of online games (χ² = 14.9106, p = 0.0001), and sports (χ² = 4.8609, p = 0.0275) were significantly higher than non-smokers’. Generalized estimating equations (GEE) found that students whose both father and mother smoke were unable to receive tobacco-related knowledge. GEE also found that students in high school, with affluent family economic condition and with an opposing attitude towards father smoking possessed a better smoking-related knowledge. However, male students with disagreement or neutral attitude towards friends smoking were negatively associated with the knowledge of smoking hazards.

Conclusions

The findings of the present study suggest that a significant proportion of male secondary school students in urban Chongqing lack specific knowledge about smoking-related diseases. Targeted educational programs for secondary school students in China are needed to promote tobacco control and tobacco use reduction and cessation among students.