Introduction:
Tobacco usage comprising smoking and non-smoking forms are common in India. Approximately half of all cancers in men in India are tobacco related, while over 60% of those suffering from heart disease below the age of 40 are smokers. India has one of the highest rates of oral cancer in the world, with 90% of the patients being tobacco chewers.[1]
Tobacco dependence of a large number of adults has been initiated during their adolescent period. The risk of tobacco usage is high among those who start early and continue its use for a longer period.[2] Thus, youths being the vulnerable age group for initiation of tobacco consumption, our study deals with youths of age group 15 – 24. Hence, the objectives of the present study were to find prevalence and tobacco pattern usage among youth (both male and female)and to find out reasons and occasions for the use of tobacco products.[3]
Materials and Methods
Study area and setting: The present community-based cross sectional study was undertaken in the field practice area of - Urban Health Training Center located in Villupuram under the Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry. The study was undertaken during the period of January to April 2014.
Sample size and sampling: Based on the Global Adult Tobacco Survey 2008-10, the prevalence of 34.6% is used to calculate the sample size for this study.[4] A representative sample of 610 youth (15 to 24 years of age) in peri-urban area of Villupuram was selected by the cluster sampling technique. In 30 clusters, 21 individuals in each cluster were selected for by house to house visits. The respondents were selected by a random walk method.
Data collection: Respondents were interviewed by using a pre-designed questionnaire. The respondents who had consumed tobacco products at least once in their life-time was considered as "ever user" and who had consumed tobacco products at least once in the past 30 days was considered as "current user".[4] Based on the Global Youth Tobacco Survey questionnaire, the questionnaire for the present study is developed.Participants were given visual cues in the form of photographs of locally available tobacco products to avoid the information bias. The participants were asked to point out the product, they had consumed in the last 30 days. The interview was conducted by two male Community Medicine post graduates.
Data analysis: The data was entered and analyzed to find out proportions and percentages using the Epi_info (version 3.5.4) software package.
Ethical consideration: Ethical clearance has been obtained from the Institutional Ethics Committee. All the ethical principles such as obtaining consent and ensuring confidentiality has been adhered to, throughout the study.After the interview for those who were found using tobacco products was explained about the health hazards of the tobacco products consumption and those who were addicted have been refered to de-addiction centre.
Results
Table 1: Socio- demographic characteristics |
Socio-demographic characteristics |
Male n=364 |
Female n=246 |
Total N=610 |
p value |
Average age
(Years + SD) |
20.4+2.8 |
19.9+2.9 |
20.19+2.84 |
0.124 |
Socio-economic condition |
BPL |
154(42.3) |
59(23.9) |
213(34.9) |
<0.001 |
APL |
206(56.6) |
178(72.3) |
384(62.9) |
<0.001 |
Doesn't have ration card/ Does not know |
4(1.09) |
9(3.7) |
13(2.2) |
0.031 |
Membership in Youth groups |
25(6.9) |
3(1.3) |
28(4.6) |
<0.001 |
Tobacco product usage |
Ever usage of tobacco |
209(57.4) |
16(6.5) |
225(36.9) |
<0.001 |
History of tobacco consumption in last 30 days
(current users) |
177(48.6) |
2(0.81) |
179(29.3) |
<0.001 |
| (Figures in parenthesis are percentages) |
Out of the 610 youths interviewed, 364 (59.7%) were males and 246 (40.3%) were females. The mean age in years (+ SD) of the male was in years 20.4(+2.8) and that of female was in years 19.9(+2.9).Overall, 154 (34.9%) youth were below poverty line. Among 28(4.6%) respondents who had membership in community based youth groups, male 25(6.9%) was significantly higher than female 3(1.3%) (p<0.001). Out of 610 respondents, 225(36.9%) youths had a history of ever usage of tobacco products in which male 209 (57.4%) was significantly higher than female 16 (6.5%)(p<0.001).Noteworthy, among 179 (29.3%) respondents had a history of tobacco consumption in last 30 days, male 177(48.6%) was significantly higher than female 2(0.81%) (p<0.001). [Table 1].
Table 2: Types of tobacco product used |
|
Male (n=177) |
(Female n=2) |
Total (N=179) |
Smokeless from |
|
Pan masala |
42(23.7) |
- |
42(23.4) |
Gutka |
36(20.3) |
- |
36(20.1) |
Khaini |
8(4.5) |
|
8(4.4) |
Dry tobacco leaves |
- |
2 |
2(1.1) |
Smoke from |
|
Beedi |
13(7.3) |
- |
13(7.2) |
Cigarette |
156(88.1) |
- |
156(87.1) |
| (Figures in parenthesis are percentages) |
As seen in the above table, among 177 boys who had consumed any tobacco products in last one month, 42 (23.7%) consumed pan masala, 36 (20.3%) and 8 (4.5%) consumed gutka and khaini respectively, 13 (7.3%) smoked tobacco in the form of beedi and 156 (88.1%) smoked in the form of cigarette. Only 2 girls had used dry tobacco leaves for other reasons like toothache [Table 2].
Among tobacco consuming male, 172 (97.2%) consumed it due to peer pressure, 14 (7.9%) due to parent usage, 74 (41.8%) due to stress, 106 (59.8%) consumed due to media influence and 89 (50.2%) consumed due to life-style changes. Two girls, who had a history of dry tobacco leaves, consumed it due to parental influence. [Table 3].
Table 3: Reasons for tobacco usage among current users (Multiple responses) |
| Reasons |
Male (n=177) |
Female (n=2) |
Total ( N=179) |
Peer pressure |
172(97.2) |
- |
172(96) |
Parent usage |
14(7.9) |
2 |
16(8.9) |
Stress |
74(41.8) |
- |
74(41.3) |
Media |
106(59.8) |
- |
106(59.2) |
Life style changes |
89(50.2) |
- |
89(49.72) |
| (Figures in parenthesis are percentages) |
Out of 177 male tobacco product users, 139 (78.5%) consumed during stress, 107 (60.4%) for cheer up, 20 (11.3%) smoked it while having coffee or tea, 53 (30%) consumed it for relief of anxiety, 92 (52%) consumed when they were bored, 26 (14.7%) consumed after meals for the digestion , 14 (8%) consumed tobacco products at their work, 74 (41.8%) used it while relaxing, 29 (16.4) used during alcohol consumption and 56 (31.6%) consumed when people around using it. Out of only 2 female tobacco users, 1 used it to cheer up and to get rid of toothache and another 1 consumed it when people around using [Table 4].
Table 4: Occasions when tobacco products are consumed (Multiple responses) |
| Occasions |
Male (n=177) |
Female (n=2) |
Total( N=179) |
Stress |
139(78.5) |
- |
139(77.6) |
To cheer up |
107(60.4) |
1 |
108(60.3) |
During coffee or tea |
20(11.3) |
- |
20(11.2) |
Anxiety |
53(30) |
- |
53(29.6) |
When bored |
92(52) |
- |
92(51.4) |
After meals |
26(14.7) |
- |
26(14.5) |
At work |
14(8) |
- |
14(7.8) |
Relaxing |
74(41.8) |
- |
74(41.3) |
During alcohol consumption |
29(16.4) |
- |
29(16.2) |
When people around using |
56(31.6) |
1 |
57(31.8) |
| (Figures in parenthesis are percentages) |
Our results shows that, out of 177 male tobacco product users, 143 (80.7%) consumed it for excitement, 72(40.6%) consumed it for stabilizing mood, 28 (15.8%) consumed it to feel drowsy and 125 (70.6%) consumed it for fun. Regarding female tobacco users, 1 (50%) used it for excitement and for fun respectively [Table 5].
Table 5: Motive for tobacco product usage (Multiple responses) |
|
Male (n=177) |
Female (n=2) |
Total (N=179) |
Excitement |
143(80.7) |
1(50) |
144(80.4) |
Mood stabilizing |
72(40.6) |
- |
72(40.2) |
Drowsy |
28(15.8) |
- |
28(15.6) |
For fun |
125(70.6) |
1(50) |
126(70.4) |
| (Figures in parenthesis are percentages) |
Out of 177 male tobacco product users, 110 (62.1%) reported to use their own earnings, 133 (75.1%) used their pocket money, 146 (82.4%) shared or borrowed from their friends and 88 (49.7%) did stealing it from elders. Regarding 2 female tobacco product users, consumed by taking it from elders without their knowledge [Table 6].
Table 6: Source to buy tobacco products |
Sources |
Male(n=177) |
Female(n=2) |
Total(N=179) |
Own earnings |
110(62.1) |
- |
110(61.4) |
Pocket money |
133(75.1) |
- |
133(74.3) |
Friends |
146(82.4) |
- |
146(81.6) |
Steal |
88(49.7) |
2(100) |
90(50.2) |
| (Figures in parenthesis are percentages) |
Discussion:
In the present study, the mean age of respondents was 20.4 (+2.8) and 19.9 (+2.9) years for male and female respectively. Among the respondents, 36.9% had consumed tobacco products at least once in their life time (ever usage), while 29.3% had consumed tobacco products at least once in the past 30 days (current usage). Notably, 48.6% were males who had consumed mostly smoke form, predominantly cigarettes (88.1%) followed by smoke less forms like pan masala (23.7%) and gutka (20.3%). The remaining (0.81%) were females who had consumed dry tobacco leaves for the tooth ache purpose. The major reasons for initiating tobacco usage were peer pressure (97.2%) and media influence (59.8%). The common occasions were when stressed (78.5%) and for cheering up (60.4%). The key motives were for excitement (80.7%) and for fun (70.6%). The main source to get tobacco products were shared or borrowed from friends (82.4%) and from their pocket money (75.1%). The information gathered in the present study is useful for the improvement of health education activities and to initiate cessation programs.
The strengths of this study were its representative sample size and random sampling. To avoid recall bias, pictures of locally available tobacco products were shown to the participants during the interview. Though, the limitations of the study should be kept in mind. Though privacy of the interview was maintained, some responses could have been biased as the interview was conducted at home, inhibitions regarding their addictions cannot be ruled out. The pattern of tobacco usage, reasons and its occasions of usage were in multiple responses.
According to school based Global Youth Tobacco Survey in India, current use of any tobacco product among school children (13-15 years) was found to be 14.1% (17.3% boys, 9.8% girls).[4] Jayakumary Muttappallymyalil et al found that the usage of tobacco products among adolescent boys was 12% and none of the girls were tobacco users in north Kerala.[5] Chokalingam et al have reported that the usage of tobacco was 39.6% among males and 5.0% among females.[6] Our study showed a higher prevalence among males (48.6%) but amongst females the prevalence was less (0.81%). Since, interview was done by a male interviewer, expect some bias in female reporting
In the urban area, youth population is more prone to get influenced due to media and Peer pressure to the tobacco smoking and chewing habits. Due to stress from various reasons and to cheer up economically the youth population depends upon the tobacco product consumption. Because of life style changes for excitement and for fun they are consuming tobacco products from their pocket money or sharing from friends when others are using around. To reduce this primary uptake of tobacco among youth population requires strict legislative regulation and health education.7As per the World No Tobacco Day 2014's theme[8] "Raise taxes on Tobacco", Government of India has increased the taxes on tobacco products recently which will help in safeguarding the health of the people.[9]
Conclusion and recommendation:
Tobacco product usage is consistently high in the youth population and it is continued in their adult age group also which is a serious threat for non communicable disease. It needs urgent public health intervention by health education and awareness programs at schools and community level. The existing legislative rules on tobacco control needs to be strengthened.
References:
- Tobacco control foundation of India. A future free of tobacco. Tobacco facts. New Delhi. (Online) (cited 2014 Jul 28). Available from: http://tobaccoindia.org/Foundation.html
- Oakley E, Demaine L, Warnakulasuriya S. Areca (betel) nut chewing habit among high school children in the commonwealth of the northern Mariana Islands(Micronesia). Bull World Health Organ. 2005;83:656-60.
- Sagarkar AR, Sagarkar RM, Arabbi KC, Shivamallappa SM. A Substantive review on tobacco use among school-going adolescents in India. J Int Soc Prevent Communit Dent 2013;3:7-11.
- India GYTS 2009 Factsheet Ages 13-15 [Internet]. [cited 2014 Jul 28]. Available from: http://www.searo.who.int/entity/noncommunicable disease/ data/ind gyts fs 2009.pdf
- Muttappallymyalil J, Divakaran B,Thomas T, Sreedharan J, Haran JC, Thanzeel M. Prevalence of Tobacco Use Among Adolescents in North Kerala,India. Asian Pacific J Cancer Prev. 2012;13(11):5883-5886.
- Chockalingam K, Vedhachalam C, Rangasamy S, Sekar G, Adinarayanan S, Swaminathan S, et al. Prevalence of Tobacco Use in Urban, Semi Urban and Rural Areas in and around Chennai City, India. PLoS ONE. 2013 Oct 1;8(10):e76005.
- Dongre AR, Deshmukh PR, Murali N, Garg BS. Tobacco consumption among adolescents in rural Wardha: Where and how tobacco control should focus its attention? Indian Journal of Cancer. July-Sep 2008:45(3)
- World Health Organization. Tobacco Free Initiative. World No Tobacco Day 2014: raise taxes on tobacco [Online]. Available from URL: http://www.who.int/tobacco/wntd/en/
- Budget 2014: High tax on tobacco will safeguard citizens, say health groups. The Economic Times. 2014 July 2 [Online]. Available from URL: http://articles.economictimes.indiatimes.com/2014-07-02/news/51030625_1_tobacco-products-tobacco-taxes-tobacco-survey-india
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