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EPIDEMIOLOGICAL WORK  
Year : 2017  |  Volume : 28  |  Issue : 4  |  Page : 465-469
Adolescent tobacco menace: Attitudes, norms, and parental influence


Department of Oral Pathology and Microbiology, Subharti Dental College, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India

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Date of Web Publication16-Aug-2017
 

   Abstract 

Background: Adolescence is a very delicate and vulnerable age when children are exposed to the harmful and damaging culture of the society. Tobacco habits are increasingly becoming an annoying menace to the Indian society since the past few years. The teenage group is fast catching up the tobacco habits because of its easy availability in the local Indian markets. Thus, this study was envisaged to analyze the factors responsible for this adverse habit and to obtain an overview of the trends in tobacco habits in young children of North India. Methods: Eight hundred and sixteen schoolchildren in the age group of 14–19 years of different schools of Meerut city were instructed to fill the prepared questionnaires. Results were formulated and statistical analysis was done. Results: Chi-square analysis revealed significant difference between tobacco users and nonusers. Smokeless habit was more prevalent among adolescent boys. Peer pressure was the most cited reason for initiating the tobacco habit while parental influence helped the most in abstaining from this adverse addiction. Conclusion: Despite the existence of anti-tobacco regulations in India, tobacco dependence in adolescents raises an alarm for the Indian community and stringent steps are required to remove this menace.

Keywords: Adolescents, parental influence, peer pressure, tobacco habits

How to cite this article:
Sharma P, Wadhwan V, Aggarwal P, Sharma N. Adolescent tobacco menace: Attitudes, norms, and parental influence. Indian J Dent Res 2017;28:465-9

How to cite this URL:
Sharma P, Wadhwan V, Aggarwal P, Sharma N. Adolescent tobacco menace: Attitudes, norms, and parental influence. Indian J Dent Res [serial online] 2017 [cited 2019 Oct 19];28:465-9. Available from: http://www.ijdr.in/text.asp?2017/28/4/465/213036

   Introduction Top


Tobacco use is a global pandemic and is the leading cause of preventable death worldwide, more so in developing countries. India is the second largest consumer and third largest producer of tobacco and it is quite disturbing to note that nearly one in ten adolescents in the age group of 13–15 years have ever smoked cigarettes and almost half of these reports initiating tobacco use before 10 years of age.[1] According to the 52nd National Sample Survey conducted by the National Sample Survey Organization in 1995–1996, the prevalence rates of consumption of tobacco in any form were found to be 51.3% for men and 10.3% for women, 15 years and older.[2],[3] As per the information collected by the National Family Health Survey on tobacco use spanning across 26 states in India, 47% of men and 14% of women either smoked or chewed tobacco, i.e. nearly 195 million people in India.[3] It is estimated that 5500 adolescents start using tobacco every day in India and become part of the 4 million young people using tobacco under the age of 15 years.[1] According to the Global Youth Tobacco Survey (GYTS) 2006, it is shocking to observe that a total of 36.9% children in India initiate smoking before the age of 10, while 4.2% students currently smoke cigarettes with rate for boys significantly higher than girls. Furthermore, 11.9% of students currently use other tobacco products. Cigarette smoking among youth is higher in central, southern, and northeastern regions (12%).[4] Despite the enaction of cigarettes and other tobacco products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA) by the Government of India,[5] still tobacco products are being sold to and by the minors (<18 years of age) within 100 yards of educational institutions. Noteworthily, warning boards have not been displayed at all points of sale and around educational institutions. According to the most recent Government of India's National Sample Survey data, there are 184 million tobacco consumers in India. About 40% of them use smokeless tobacco, 20% consume cigarettes, and another 40% smoke beedis.[6] In contrast to other parts of the world, tobacco is used in a variety of ways in India, which include smoking and smokeless tobacco use.[6] The Indian government is alarmed that the age at the first use of tobacco has been reduced considerably. Thus, it is important to understand various factors that influence and encourage young teenagers to start smoking or to use other products.

Hence, this study was undertaken to concentrate on this special group of population who can carve out a niche in their future in terms of healthy lifestyle. This study was planned to look into the extent of tobacco use among adolescents in the randomly selected schools of Meerut city situated in North India and also to find the extent of the prevalence of tobacco use among adolescents, their knowledge, attitude, and perception of tobacco use. We aimed to unleash the reasons for the use of tobacco products, i.e., smoking or smokeless products and to judge the factors that cause the adolescents to abstain from tobacco products. The present research also intended to find the most common sources of knowledge about the hazards of smoking.


   Methods Top


Data collection and analysis

The study was carried out in randomly selected schools of Meerut covering a total of 816 teenagers in the age group of 14–19 years. Anonymous and confidential self-administered questionnaire was distributed among the students. The questionnaire was adapted from the GYTS, which covered the demographic details, tobacco habit patterns, reasons for initiating tobacco use, the influence of parents, teachers, and media in initiating as well as quitting tobacco use. Elaborative briefing on the questionnaire was done to all the students of the class prior to data collection. Students in middle (14–15 years) and late adolescence (16–19 years) from grades 9, 10, 11, and 12 were included for this research. Out of these, 736 completed the questionnaires with a response rate of 90.1%. Among the rejected questionnaires, 66 were incomplete, whereas 14 did not match the age criteria, therefore these were excluded from the data analyses. The tobacco habit was broadly classified into three categories – smoked tobacco, smokeless tobacco, and mixed tobacco. Students were asked to indicate their reasons for smoking or nonsmoking based on factors such as parental smoking status, peer influence, fun and enjoyment, academic performance, and inquisitiveness. The data thus obtained were analyzed using SPSS software, version 10.0 (Statistical Package for the Social Sciences, developed by IBM Corporation) and the same is presented here. The Karl Pearson and Chi-square tests were applied to determine the statistical significance of association at 5% level of significance.


   Results Top


Tobacco habits

In the present study, among 736 adolescents who were interviewed, 296 (40.2%) were tobacco users, whereas the remaining 440 (59.7%) were nonusers [Table 1]. Chi-square test was applied and significant association was found between adolescents and the different types of tobacco.
Table 1: Gender distribution of adolescents - tobacco users

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Adolescent boys have high rate of tobacco use, with smokeless tobacco users scoring over smokers [Table 2]. The present study revealed that, out of a total of 402 adolescent boys, 68.1% were tobacco users; while out of 334 adolescent girls, only 6.6% of the girls were tobacco users. The difference between tobacco users and nonusers among adolescent boys and girls was found to be statistically highly significant (P < 0.01, i.e., probability measure). The comprehensive analysis of the data observed that the mean duration of smoking was 1.8 years [Table 3].
Table 2: Gender distribution of different types of tobacco habits

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Table 3: Types of tobacco users

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In the present study, the use of gutkha by the adolescent boys is found to be significant and use of smokeless tobacco by girls is high (6.7%). The factors which lead the adolescents to initiate smoking were also analyzed and we observed that peer influence was the major reason for initiation of smoking. Parental smoking was the second most important influencing factor in this research [Figure 1].
Figure 1: Factors leading to initiation of tobacco habits.

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In addition, reasons for not indulging in tobacco habits were also formulated in this study which revealed that parental influence played a highly important role in abstaining from tobacco habits (76.8%). While wastage of money and health concern were the other major reasons (63.6% and 61.3%, respectively) [Figure 2]. Hindrance in studies was cited by 34% while only 4% answered that it was against their religion. The students were also interviewed about their sources of knowledge about the hazards of tobacco habits. Majority of the students opined that teachers (70.6%) and parents (65.2%) were the most important source of information about the hazards of tobacco habits. Media was cited by 11.9% of the students in the present study.
Figure 2: Reasons for not indulging in tobacco habits in nonusers of tobacco

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Quitting the tobacco habit

Pearson's Chi-square test was applied to find a correlation between the type of tobacco users and their willingness to quit the habit. No significant association was found between the wishers for stopping tobacco habit and the type of tobacco users (P < 0.01). However, a significant association was observed between the types of tobacco users and the attempts for quitting the habits. Nearly 45% of them attempted quitting, though a significantly higher proportion was found among occasional smokers. Our study observed that 45.6% of regular and occasional tobacco users were not willing to quit. Only 32.7% expressed their wish to stop. While 21.6% were uncertain of their choice to quit.


   Discussion Top


According to the WHO estimates, about 194 million men and 45 million women use tobacco in smoked or smokeless form in India. As per the WHO reports, the rate of tobacco consumption in developing countries was an epidemic and was the main cause of lung and oral cancers. To develop and implement effective measures of smoking control, one must understand the reasons and risk factors for smoking initiation. Numerous Indian studies suggest that the mean age of the initiation of tobacco use varies from 8 to 15 years.[7],[8],[9]

The present study showed that, out of a total of 402 adolescent boys, 68.1% were tobacco users; while out of 334 adolescent girls, only 6.6% of the girls were tobacco users, which is much more as compared to tobacco using boys (18.5%) and girls (15%) reported by Sinha et al. from Bihar.[10] In addition, the use of gutkha by the adolescent boys is found to be significant and use of smokeless tobacco by girls is high (6.7%), simulating the results of studies conducted in Bihar [10] and Wardha.[11] Use of Nas/mishri by girls was found to be very high in Wardha population.[11] This is a very important finding as smokeless form has much more deleterious effect on health than plain tobacco and is one of the most highly advertised smokeless form tobacco products in all the media.

As per the GYTS conducted on schoolchildren of age groups 13–15 in 12 countries (China, Sri Lanka, Jordan, Zimbabwe, etc.), current cigarette smoking was found to vary from 15% to 70% across different countries.[12] Tobacco use, especially smoking, is a male-dominated phenomenon among children and adolescents in India.

According to a door-to-door survey conducted in a village of Wardha district of India on the adolescent group, 46.83% of the adolescents were tobacco users. While, on the contrary, Parwal and Mukherjee [13] from Gujarat reported 24.9% of adolescents as tobacco users. The data collected from the present study revealed 40.21% of the adolescent population as tobacco users. A study conducted in Noida city in North India among adolescents of 11–19 years revealed that overall, the tobacco use in any form (smoking and smokeless forms) was significantly more in boys as compared to girls.[14] In developing countries like India, use of tobacco by men is 40%–60%, whereas in women, it is 2%–10%. This habit of tobacco use starts during adolescent period as revealed in many studies.[13],[14]

Studies have suggested several determinants or risk factors for tobacco use. These include favorable attitude toward tobacco use, inadequate knowledge about tobacco and health, family tobacco use, tobacco use among friends, and family problems in the school.[15] In the present study, peer influence (friends or co-workers) was the major reason for the initiation of tobacco habit (both smokeless and smoking), similar to findings of other studies.[16],[17],[18] Other factors responsible for initiation of tobacco use were poor academic performance and stress. Nearly 80% consumed tobacco for fun and enjoyment, according to some studies. Studies have reported that the likelihood of being a smoker increases among academically poorly performing students.[19] The present study supports the peer influence factor which comprises two types of peer pressure, i.e., having close friends who smoke and having close friends who encourage them to smoke. Similar results were reported from junior and senior high school students in China, Spain, and Japan.[20],[21],[22] A study conducted in India also reported that, in 62.3% of users, the source of initiation was friends and 4.7% children imitated their parents' smoking habits.[23] Media was cited by 11.95% of the students as the source of knowledge about the tobacco products. In contrast, mass media was the leading source of information by other studies.[20] However, we believe that mass media cannot replace face-to-face communication between a student and a doctor, a teacher, or parents.

Pearson's Chi-square test was applied which showed no significant association between the wishers for stopping tobacco habit and the type of tobacco users. However, a significant association was observed between the types of tobacco users and the attempts for quitting the habits. According to a survey carried out by Naing et al., 2004,[24] more than 50% of regular and occasional smokers expressed their wish to stop smoking. Nearly 45% of them attempted quitting, though a significantly higher proportion was found among occasional smokers. Our study observed that 45.6% of regular and occasional tobacco users were not willing to quit. Only 32.7% expressed their wish to stop. While 21.6% were uncertain of their choice to quit. This suggests that there was a desire to quit the adverse habit despite the fact that it is difficult to stop the habit once it has become established.

The response rate was 90% in the present study, suggesting that the nonresponders' attitudes and characteristics could not be interpreted from the study, thus constituting an important limitation of the study. In addition, the findings are heavily dependent on the self-reported questionnaire which may not always be authentic, thus pointing to another limitation of the study. Longitudinal studies have observed that older adolescents tend to report a later age of smoking onset than younger ones.[14] Furthermore, reporting of smoking behavior and reasons for initiation of tobacco may differ from the actual habit patterns.

According to a survey done by the National Sample Survey Organization of the Indian government, the status of tobacco consumption in India is highly disappointing as approximately 20 million children aged 10–14 years are estimated to be tobacco addicted. To this astounding figure, about 5500 new users are added every day, totaling to 2 million new users every year. A couple of programs by nongovernmental organizations (NGOs), for offering need-based intervention, under the auspices of the WHO, UNICEF, and Ministry of Health and Family Welfare of Indian government, have been conducted. The UNICEF is conducting training courses for NGOs and street educators who are expected to find and help the street children abusing drugs.[8]


   Conclusion Top


Preventive strategies are already being used in India such as spreading awareness about the hazards of tobacco, curbs on advertisement and promotional campaigns, early identification of the users, restrictions on sales and tobacco use in public places such as railway stations, airports, hospitals, and government offices, and providing treatment. However, the present study confirms that the tobacco habits in adolescents have reached alarming proportions and definitely is a warning of an impending epidemic in India and thus justifies the need for making zealous efforts in continuing the anti-tobacco drive in India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

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Correspondence Address:
Preeti Sharma
BH-15, Pallavpuram, Phase - I, Meerut - 250 110, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.IJDR_31_16

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