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Year : 2017 | Volume : 5 | Issue : 2 | Page : 68 - 70  


Original Articles
Prevalence of tobacco smoking and impact of peer groups on smoking behavior among adolescent students

Ved P. Kulkarni1, P. Prabhakar Varma2

1 Professor, 2 P. G. Student, Department of Community Medicine, Maharajahs Institute of Medical Sciences, Nellimarla, Vizianagaram, Andhra Pradesh

Corresponding Author:

Dr. Ved P. Kulkarni

Email: vedkulkarni1974@gmail.com

ABSTRACT:

Background: Tobacco in both smoked and smokeless forms is a major killer world wide. It is responsible for100 million premature deaths in the 20th century, and if the current trends of tobacco use continue, this number is expected to rise to 1 billion in the 21st century.

Objectives: To study the prevalence of tobacco smoking among adolescent students in rural and urban schools in Vizianagaram, and to study the impact of peer groups on their smoking habit, To give suitable recommendations based on findings of this study.

Methods: A community based observational cross sectional study was conducted for a period of 2 months among adolescent boys aged 13 to 16 years attending high school from rural and one from urban area were selected by simple random technique and direct one to one interview was done among all the students who are willing to participate in the study. A total of 194 students were interviewed.

Results: In the current study it was observed that 10.3% of the participants were current smokers. The mean age of initiation of smoking was found to be 14.1+0.912 years. Peer group influence on smokers in rural area was found to be 58.33% and in urban area it was about 62.5%.

Conclusion: It is concluded that adolescent youth smoking is prevalent at high level in both urban and rural areas. It is showing an increase in attitude towards smoking among adolescent youth which has to be reduced with necessary interventions like health education and surveillance by the elderly at home and teachers at school. Peer group impact is found to be at alarming proportion in the study which has to be controlled by educating the peer as a first step.

Key words: Tobacco, smoking, adolescent, peer group

INTRODUCTION:

Tobacco use kills nearly six million people worldwide each year. According to the World Health Organization (WHO) estimates, globally, there were 100 million premature deaths due to tobacco in the 20th century, and if the current trends of tobacco use continue, this number is expected to rise to 1 billion in the 21st century. 1 Tobacco use, including second hand smoke is linked to rising incidence of various cancers.

Tobacco smoking is risk factor for many cancers, IHD and gastrointestinal problems, stroke, Burgers disease, Thrombo Angitis Oblitrance (TAO) etc. Indias tobacco problem is very complex, with a large use of a variety of smoking forms and an array of smokeless tobacco products. Many of these products are manufactured as cottage and small-scale industries using varying mixtures and widely differing processes of manufacturing. 2

Tobacco products are sold predominantly at small shops. Hence, banning the sale of these products to less than 21 year olds can hardly be enforced. The very fact that 15 to 24 year olds account for over 27% of tobacco consumption in India clearly indicates that sale to those below 18 years, which is currently not allowed, is a reality. Indias public health policy is thus pitted against tobacco sector with enormous political influence. Both tobacco and alcohol are now accessible to adolescents with strong influence on their entire life.

According to the National Family Health Survey (NFHS)-3 survey, conducted in 2005–06, tobacco use is more prevalent among men, rural population, illiterates, poor and vulnerable section of the society. 3 India has a massive market for tobacco although consumption patterns differ from other countries. Published data from Adult Global Tobacco Survey indicates that number of tobacco users (age 15 & higher) in India is 274.9 million, compared to 300.8 million in China. The intensity of smoking is 6.1 cigarettes per day while various other forms like bidi, chewing tobacco & snuff are consumed heavily, even in combination.

If national health is to be improved, country has to take up a mission to turn tobacco fields into fruit orchards, as one expert puts it.

Hence this study was carried out to study the prevalence of tobacco smoking in adolescent students of rural and urban schools in Vizianagaram district and to study the impact of peer groups on their smoking behavior.

MATERIAL & METHODS:

Study design: A Community based observational Cross-sectional study

Study setting: Government school at Gurla (rural) and government school at VT Agraharam (urban) in Vizianagaram District.

Study subjects: Adolescent boys attending high school.

Study period: 2 months (June – July, 2016)

Sampling method and size: One government school in rural area and one government school in urban area were selected by simple random technique and all the adolescent students in the age group 13 to 16 years were studied.

Study instrument: Pre designed, Pre tested, semi-structured Questionnaire.

Method of data collection: Direct one to one interview was conducted.

Data analysis: Data was compiled on Windows Excel Spreadsheet. Percentages and appropriate tests of significance were applied wherever necessary.

RESULTS:

The mean age of initiation of smoking in this study is found out to be 14.1+0.912 years.

Table 1: Prevalence of smoking in rural and urban adolescent boys

Prevalence of smoking in rural and urban adolescent boys

Rural (n=96)

Urban (n=98)

Smokers

12(12.5%)

8(8.16%)

Non smokers

84(84.5%)

90(91.8%)

Total

96

98

*z value 0.99

Table 1 show that the prevalence of smoking in rural adolescent boys is 12.5% where as in urban boys is 8.16%. The overall prevalence is found out to be 10.3% both urban and rural together. There is no significant difference in prevalence of smoking among rural and urban adolescent boys.

Table 2: Type of tobacco used by adolescent smokers in rural & urban areas

Types of tobacco used

Rural (n=96)

Urban (n=98)

Cigarette

8 (66.66%)

7 (87.5%)

Bidis

2 (16.66%)

1 (12.5%)

Gutkha

1 (8.33%)

0 (0%)

Pan masala

1 (8.33%)

0 (0%)

Total

12

8

Table 2 shows that cigarette was the most widely used tobacco product in both rural (66.66%) and urban (87.5%) areas. Gutkha and pan masala use was 8.33% each in rural areas whereas there was no use of these products by adolescent boys in urban areas.

Table 3: Peer group influence on smoking behavior in rural area. (n=96)

 

Influenced

Not influenced

Smokers

7 (58.33%)

5 (41.67%)

Non smokers

12 (14.29%)

72 (85.71%)

*chi square value = 12.831, P value < 0.001 (highly significant)

Table 3 shows that the influence of peer group among smokers is 58.33% whereas in non smokers its influence is 14.29% in rural area which is highly significant with p value <0.001 indicating that this is a major factor contributing to increasing incidence of smoking among adolescents.

In rural area influence of peer group on smokers was 58.33% whereas in non smokers it was 14.29%.

This difference is statistically highly significant. (P value <0.001)

Table 4: Peer group influence on smoking behavior in urban area. (n=98)

 

Influenced

Not influenced

Smokers

5 (62.5%)

3 (37.5%)

Non smokers

6 (6.67%)

88 (94.33%)

*Chi square value = 19.71, P value <0.001 (highly significant)

Table 4 shows that 62.5% of the smokers were influenced by peer groups. Peer group influence on non smokers was 6.67% which is low when compared to smokers but it should be given attention as that may lead to incidence of smoking in near future. The difference in influence of peer groups on smokers and non smokers is statistically highly significant. (P value <0.001)

DISCUSSION:

This study shows various aspects related to smoking behavior in adolescents. Many complex socioeconomic factors come into play in deciding the age at initiation of smoking as well as prevalence of smoking in the adolescents.

The mean age of initiation of smoking in this study is found out to be 14.1+0.912 years. Similar findings were reported by Raj Nayaran et al who observed that mean age at initiation of smoking in adolescents was 12.4+1.9 years 9. Gajalaxmi V. et al reported that 35% adolescents initiated cigarette smoking before age 10. 7

Reddy KS et al quoted that the average percentage of ever-smoker adolescents who smoked their first cigarette before the age of 10 years was 54%. 8 Rahul Sharma et al10 reported that 40% of ever smokers had first smoked a whole cigarette/bidi at an age of ≤13 years.10

The prevalence of smoking in rural adolescent boys is 12.5% where as in urban boys is 8.16%. Similar findings are reported by Gajalaxmi V. et al 7 (14.6% of adolescents smoking) and Reddy KS et al (17.5% of adolescents smoking). 8

Cigarette is the most widely used tobacco product in both rural (66.66%) and urban (87.5%) areas.

Bidis are more popular in rural boys, apparently because of cost factor (16.6% v/s 12.5%). Reddy KS et al noted that bidi smoking in rural areas (5.0 %) was significantly higher than urban areas (2.4 %). 8 Gajalaxmi V. et al reported 5.3% of adolescents using bidis. 7

Gutkha and pan masala use is 8.33% each in rural areas. Similar findings are reported by Gajalaxmi V. et al quoting 9% use of smokeless forms of tobacco by the adolescents. 7 Reddy KS et al reported that smokeless tobacco use is 13.6% in adolescents. 8

This study found the influence of peer group among smokers is 58.33% in rural area whereas influence of peer groups among smokers is 62.5% in urban area. These findings are consistent with Rahul Sharma et al who reported that tobacco use was five times more likely if students had seen their sibling ever smoke (odds ratio 5.15, 95% confidence interval: 2.16–12.26), three times more likely if a best friend smoked (OR 2.92, 95% CI: 1.72–4.94). 10

Reddy KS et al noted that tobacco users were more likely than never-tobacco users to admit that most or all of their friends smoke.8

The present study highlights the fact that initiation of smoking by adolescents is substantial and peer group influence is an important deciding factor in initiation and continuation of smoking. This study also underlines the fact that in changing socioeconomic scenario, peer influence is more powerful in shaping behavior of adolescents than family influence.

CONCLUSION:

Cigarette smoking is emerging as a disturbing trend among Indian adolescents. Peer group pressure appears to be the decisive factor in initiation and maintenance of smoking. Key to control of smoking lies in health education, group counseling and individual counseling against smoking. Nicotine chewing gum, e- cigarette use also has a role in de-addiction activity.

REFERENCES:

  1. The MPOWER package, warning about the dangers of tobacco. Geneva: WHO; 2011. WHO Report on The Global Tobacco Epidemic, 2011.
  2. Jha P, Jacob B, Gajalaxmi V et al. A nationally representative case–control study of smoking and death in India. N Engl J Med 2008;358:1137–47.
  3. Gupta PC, Pednekar MS, Parkin DM et al. Tobacco associated mortality in Mumbai (Bombay) India. Results of the Bombay Cohort Study. Int J Epidemiol. 2005;34:1395–402.
  4. Ramadas K, Sauvaget C, Thomas G et al. Effect of tobacco chewing, tobacco smoking and alcohol on all-cause and cancer mortality: A cohort study from Trivandrum, India. Cancer Epidemiol. 2010;34(4):405–12.
  5. Morbidity and Health Care. Vol. 1. Mumbai: IIPS; 2007. International Institute for Population Sciences (IIPS) and Macro International. 2007. National Family Health Survey (NFHS-3), 2005-06: India; pp. 426–8.
  6. Global Adult Tobacco Survey (GATS) India: 2009-2010. [Last accessed on 2011 Jun 17]. Available from: http://www.searo.who.int/LinkFiles/Regional_Tobacco_Surveillance_System_GATS_India.pdf. Published by IIPS, Mumbai and funded by the Ministry of Health and Family Welfare, GOI 2010.
  7. Gajalaxmi V, Kanimozhi CV. A Survey of 24,000 Students Aged 13–15 Years in India: Global Youth Tobacco Survey 2006 and 2009. Tobacco Use Insights. 2010;3:23–3.
  8. Reddy KS, Gupta PC, editors. Report on Tobacco Control in India (New Delhi, India) New Delhi, India: Ministry of Health and Family Welfare; 2004.
  9. Raj N, Sarita S, Gupta A et al. Age at initiation & prevalence of tobacco use among school children in Noida, India: A cross-sectional questionnaire based survey. Indian J Med Res 2011;133:300-7.
  10. Rahul S, Vijay LG, Sanjay C. Tobacco Use Among Adolescent Students and the Influence of Role Models: Indian J Community Med 2010;35(2):272-5.




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