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ORIGINAL RESEARCH Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 3  |  Page : 346-349
Factors attributing to initiation of tobacco use in adolescent students of Moradabad, (UP) India


Department of Community Dentistry, Kothiwal Dental College and Research Centre, Moradabad - 244 001, Uttar Pradesh, India

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Date of Submission19-Oct-2007
Date of Decision20-Dec-2008
Date of Acceptance23-Apr-2009
Date of Web Publication30-Oct-2009
 

   Abstract 

Background: Tobacco consumption is a major health menace owing to its widespread use particularly among adolescents. Owing to the presence of impressionable, curious minds, adolescents are highly prone to a number of influences within and outside home, leading them to experiment with tobacco. The addictive nature of tobacco is potent enough to turn these experimental users to addicts.
Objectives:
To identify the prominent factors leading to initiation of tobacco use among adolescents of Moradabad.
Materials and Methods: Two-stage sampling was used to identify 590 adolescents (study population) from four senior secondary schools in Moradabad. The response towards tobacco, and its use, was assessed through structured questionnaires. Responses of all study population and association between dependent and explanatory variables were assessed using c2 test (Chi-square test) using SPSS package (version 12).
Results: The study results show that 17.3% of the adolescents have experimented with tobacco. Curiosity and peer pressure were the main reasons behind trying tobacco. Parental tobacco status, especially place of use (at home or outside), had a significant influence on adolescents experimenting tobacco .
Conclusion:
Tobacco use by parents is likely to influence adolescents, as they perceive tobacco use as a positive and acceptable behavior, and develop favorable personal beliefs and subjective norms towards tobacco use.

Keywords: Adolescents, experimental tobacco use, parental tobacco use

How to cite this article:
Ravishankar T L, Nagarajappa R. Factors attributing to initiation of tobacco use in adolescent students of Moradabad, (UP) India. Indian J Dent Res 2009;20:346-9

How to cite this URL:
Ravishankar T L, Nagarajappa R. Factors attributing to initiation of tobacco use in adolescent students of Moradabad, (UP) India. Indian J Dent Res [serial online] 2009 [cited 2015 Mar 27];20:346-9. Available from: http://www.ijdr.in/text.asp?2009/20/3/346/57382
Tobacco use is unique in terms of its current and projected future impact on global mortality. If the current trend continues, the number of people killed by tobacco use will be more than 10 million annually by the year 2030. [1]

Tobacco use often begins before adulthood. The global youth tobacco survey shows that a disturbingly high number of school children between the age of 13 and 15 years are currently using or have tried tobacco. [2] Addiction to nicotine occurs faster in young smokers. Recent research suggests that some adolescents begin to experience loss of control over their smoking within weeks of smoking the first cigarette. [3]

The risk of developing tobacco related cancer and chronic heart and lung diseases is greater in young adolescents., The damaging and harmful effects of tobacco usage on oral health are now well recognized. These include, in particular, a higher prevalence and severity of periodontal diseases and malignancies among smokers. [4],[5] Even experimental use of tobacco in adolescence significantly increases the risk of adult addicting to tobacco as well as the risk of disease and death. [6]

This study has been designed to identify and analyze the factors leading to initiation of experimental tobacco use among adolescent students of Moradabad (UP) India.


   Materials and Methods Top


The study sample consisted of adolescent students aged 12-15 years attending various senior secondary schools in Moradabad, (Uttar Pradesh) India. A two-stage sample design was used to produce a representative sample. In the first stage four schools were selected and in the second stage students were selected from these schools using a Table of random numbers. The required sample size was estimated to be 592 based on the results of pilot study in which prevalence was found to be 18% at an acceptable error of three per cent and confidence level of 95%. Assuming 90% response rate, 650 students were considered as final sample size. These four senior secondary schools were selected based on Probability Proportional to Enrolment size (PPE) i.e. the schools with high number of students are more likely to be selected than schools with low number of students.

A questionnaire with a set of 15 questions was prepared. These close-ended questionnaires covered questions regarding tobacco use, factors leading to its initiation, type of tobacco consumed, attitude towards tobacco use, awareness about health risk and others. The questionnaire was pre-tested among 25 adolescent students of KCM School, Moradabad, so as to confirm its validity and reliability and to avoid ambiguity. Following the pre-test, some modifications in the order of questions and terminologies were made in the final questionnaire. It was designed in such a way that the procedure should not take more than 10 minutes for an individual keeping in mind the interest and co-operation of adolescent students.

Before the start of study, permission was obtained from the ethical review board of the institution; prior permission was also obtained from respective school authorities. The time and date of the survey was intimated to the students well in advance and informed consent was obtained. Considering the sensitivity of the issue, the school authorities were requested not to be present in the class during the procedure of filling the questionnaire. Students were assured that the information they provided would remain confidential and thus were encouraged to be truthful in their response. The students were instructed to give only one answer for each question, which they felt, was most appropriate. Out of 650 questionnaires distributed, 60 questionnaires were not duly filled or had some inconsistencies which enabled us to exclude the same. So a total of 590 questionnaires were considered for analysis.

Preliminary descriptive analysis was used to assess the distribution of responses of all study variables and association between dependent and explanatory variable was assessed using c2 test (Chi-square test) using SPSS package (version 12).


   Results Top


In the study, 590 adolescent students from senior secondary schools of Moradabad formed the study sample. The boys were 454 in number as against girls who were 136 in number. About 88 (19.4%) of the boys and 14 (10.4%) of the girls have tried to use tobacco once or more before this study i.e. experimental tobacco use [Figure 1]. The commonest age group was 14-15 years during which the subjects first tried to use tobacco [Figure 2]. Various reasons are attributable for trying tobacco, among which curiosity ranked highest 36 (35%) closely followed by peer pressure 32 (31.4%). About 16 (15.7%) subjects tried tobacco to impress the opposite sex. A few attempted it to show that they have grown up or merely as an extension of family practice [Figure 3].

Out of 14 girls, 10 (71.4%) and among 88 boys, 50 (65.9%) tried smokeless forms of tobacco like gutka, paan masala, Khaini etc. Four (26.6%) girls and 30 (44.1%) boys had tried smoking which included cigarette/beedi or pipes.

A significant effect of parental use was reflected on the subjects in this study. Among 166 parents using tobacco, 38 (22%) adolescent students tried it. Among 424 parents, who do not use tobacco, only 64 (15%) of the adolescent students tried it. The place of tobacco use by parents, in the home or outside also was found to have a significant effect on subjects trying tobacco. In the group of parents where 92 (55.4%) of them used it in home, 26 (28.5%) of their children tried it. In contrast, among 74 (44.6%) parents who used tobacco outside home, only 12 (16.2%) of their subjects tried tobacco. This was found to be statistically significant [P ≤ 0.001, [Table 1]]. The awareness regarding health hazards inflicted by tobacco use was good; out of 590 subjects 83% were aware of the disastrous effects of tobacco on health.


   Discussion Top


This study provides an overview of tobacco use among adolescent students of Moradabad and enables us to determine the factors, the most risky period of initiation of tobacco use and the best period to implement available anti tobacco strategies.

Nearly 102 (17.3%) of adolescent students studying in senior secondary schools are experimental users i.e. who have tried tobacco at least once or more. This result is significantly less as compared to Global Youth Tobacco Survey (GYTS) carried out at Romania in 2003, which showed that 56.7% of 13-17 year olds have experimented with tobacco [7] and also in Serbia and Hungary [8] which may be related to the cultural and geographical differences between these countries.

The common age of first experimenting with tobacco is 14- 15 years. Curiosity and peer pressure were the main reasons for experimenting with tobacco during adolescence. The relationship with the peer group becomes stronger than family member and the young people are influenced more by the habits of their friends. Imitating the behavior of friends is a common practice among adolescents (Erikson theory). [6],[9] However, other studies have reported somewhat similar observations showing initiation of tobacco use at the age of 13-14 years in most of the countries. [10]

The proportion of experimenting with tobacco is higher in boys than girls. Boys in Indian culture enjoy higher level of freedom regarding their individual behavior than girls both in the family and society. [11] The recent study from Turkey also showed that boys were more likely to use tobacco as compared to girls. [12] The most popular form, among adolescents who had experimented tobacco products has been smokeless tobacco (Pan Masala, Gutka etc) (66.7%). This may be because of lack of knowledge of the ingredients and health hazards of pan masala, gutka and confusion of these products as mouth freshener or processed betel nut. Many use smokeless tobacco to "TREAT" toothache, headache and stomachache. This false impression promotes tobacco use among youths. [13] In addition smokeless tobacco products were convenient to hide from their parents and teachers and they are less expensive, easier to use and easily available.

Around 28% of adolescent students reported that at least one of their family members was a tobacco user. This result is similar in the median prevalence of 30.6% in a cross sectional household survey from 26 states of India [14] and less than the prevalence of other countries. This may be because of the fact that in India smokeless tobacco is commonly used and parents may bluff their children saying it's a mouth freshener or something that helps digestion. [13]

The result also shows a positive correlation between parental use and adolescents experimenting with the tobacco product. Tobacco use by family members is likely to influence adolescents; they are more likely to perceive tobacco use as a positive and acceptable behavior. This helps them develop favorable personal beliefs and subjective norms on tobacco use. Adolescent students who live in homes where the members regularly use tobacco were 1.46 times more likely to use tobacco than those not exposed to environmental tobacco smoke at home. [15] This has been reflected in other studies conducted around the world showing that the parents who used tobacco at home had greater impact on their children to experiment tobacco product as it grants them easy access to tobacco products in the household. [16],[17],[18],[19],[20],[21] Although majority of adolescents have good knowledge of the hazards of tobacco on health; the lack of complete knowledge, to some extent, had influenced adolescent experimenting with tobacco.


   Conclusion and Recommendation Top


Nearly 17.3% of the adolescents experimented with tobacco products by the age of 14 to 15 years and may be potential regular users of the future. So a comprehensive preventive program has to be developed to prevent adolescents from experimenting with tobacco, which should include school based educational programs, parental counseling to regulate the influence of tobacco use on their children and programs to protect adolescents from being exposed to the tobacco use of others.

Some of the other independent variables such as the stress, promotional advertisements, and exposure to environmental tobacco smoke on adolescent's tobacco behavior were not analyzed. Further studies are needed to assess the effects of these variables.

 
   References Top

1.Jha P, Ranson MK, Nguyen SN, Yach D. Estimates of global and regional smoking prevalence in 1995 by age and sex. Am J Public health 2002;92:1002-6.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.The Global Youth Tobacco Survey Collaborating Group. Tobacco use among youth: A cross-country comparison. Tob Control 2002;11:252-70.  Back to cited text no. 2      
3.DiFranza JR, Savageau JA, Rigotti NA, Fletcher K, Ockene JK, McNeill AD, et al. Development of symptoms of tobacco dependence in youths: 30-month follow up data from the DANDY study. Tob Control 2002;11:228-35.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Papapanou PN. Risk assessments in the diagnosis and treatment of periodontal diseases. J Dent Educ 1998;62:822-39.  Back to cited text no. 4  [PUBMED]    
5.Johnson NW, Warnakulasuriya KA. Epidemiology and aetiology of oral cancer in the United Kingdom. Community Dent Health 1993;10:13-29.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]  
6.Tyas LS, Pederson L. Psychosocial factors related to adolescent smoking: A critical review of the literature. Tobacco Control 1998;7:409-20.  Back to cited text no. 6      
7.National Center for Chronic Disease Prevention and Health Promotion, Global Youth Tobacco Survey; available on the web page of National Center for Chronic Disease Prevention and Health Promotion. Available from: http://www.cdc.gov/tobacco/global/GYTS/factsheets/2004/pdf/Romaniafactsheet.2004.pdf. [cited on 8 th august 2007].  Back to cited text no. 7      
8.National Center for Chronic Disease Prevention and Health Promotion, Global Youth Tobacco Survey; available on the web page of National Center for Chronic Disease Prevention and Health Promotion. Available from: http://www.cdc.gov/tobacco/global/gyst/GYTS_countryreports.htm. [cited on 9 th August 2007].  Back to cited text no. 8      
9.Qidwai W, Zahid N. Characteristics of smokers and their knowledge about smoking at a teaching hospital in Karachi. Pak J Med Sci 2005;21:109-11.  Back to cited text no. 9      
10.Conrad KM, Flay BR, Hill D. Why children start smoking cigarettes: Predictors of onset. Br J Addict 1992;87:1711-24.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]  
11.Jindal SK, Aggarwal AN, Chaudhry K, Chhabra SK, D′Souza, Gupta D, et al. Tobacco smoking in India: Prevalence, quit-rates and respiratory morbidity. Indian J Chest Dis Allied Sci 2006;48:37-42.  Back to cited text no. 11      
12.Nevbahar Ertas. Factors associated with stages of cigarette smoking among Turkish youth. Eur J Public Health 2007;17:155-61.  Back to cited text no. 12      
13.WHO. Tobacco in SEAR: A health challenge. WHO, SEAR, New Delhi.  Back to cited text no. 13      
14.Rani M, Bona S, Jha P, Nguyen SN, Jamjoum L. Tobacco use in India: Prevalence and predictors of smoking and chewing in a national cross-sectional household survey. Tob Control 2003;2:e4.  Back to cited text no. 14      
15.Deepak Paudel. Tobacco use among adolescent students in secondary schools of Pokhara sub metropolitan city of Nepal. A thesis submitted to Tribhuvan University Kathmandu. 2003.  Back to cited text no. 15      
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19.De Vries H, Engels R, Kremers S, Wetzsel J, Mudde A. Parents and friends smoking status as predictors of smoking onset: Findings from six European countries. Health Educ Res 2003;18:627-36.  Back to cited text no. 19      
20.Holm K, Kremers S, DeVries H. Why do Danish adolescents take up smoking? Eur J Public Health 2003;13:67-74.  Back to cited text no. 20      
21.Farkas AJ, Gilpin EA, White MM, Pierce JP. Association between household and workplace smoking restrictions and adolescent smoking. JAMA 2000;284:717-22.  Back to cited text no. 21  [PUBMED]  [FULLTEXT]  

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Correspondence Address:
T L Ravishankar
Department of Community Dentistry, Kothiwal Dental College and Research Centre, Moradabad - 244 001, Uttar Pradesh
India
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DOI: 10.4103/0970-9290.57382

PMID: 19884721

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