INDIAN JOURNAL OF COMMUNITY HEALTH / VOL 30 / ISSUE NO 03 / JUL - SEP 2018 [Youth Tobacco Survey…] | Patel GM et al

ORIGINAL ARTICLE

Youth Tobacco Survey among the School Going Adolescents in a Block of

Vadodara District, Gujarat.
Geetika M Patel1, Dhara I Zalavadiya2, Ebbie Thomas3, Ranjit K Jha4, Naresh R Godara5, Nikhil J Patel6
1
Assistant Professor, Preventive and Social Medicine, Parul Institute of Medical Sciences and Research, Gujarat
391760, 2Assistant Professor, Preventive and Social Medicine, Parul Institute of Medical Sciences and Research,
Gujarat 391760, 3Msc Biostatistics, Tutor, Preventive and Social Medicine, Parul Institute of Medical Sciences and
Research, Gujarat 391760, 4Professor, Preventive and Social Medicine, Parul Institute of Medical Sciences and
Research, Gujarat 391760 5Professor, Preventive and Social Medicine, Parul Institute of Medical Sciences and
Research, Gujarat 391760 6Assistant Professor, Preventive and Social Medicine, Parul Institute of Medical Sciences
and Research, Gujarat 391760
Abstract Introduction Methodology Results Conclusion References Citation Tables / Figures
Corresponding Author
Address for Correspondence: Dhara Zalavadiya, C/O Ashish Bhalodiya, 205, Everest Tricon App.,
behind Bright Day School, Vasna-Bhayli road, Vadodara, Gujarat 390002
E Mail ID: [email protected]

Citation
Patel GM, Zalavadiya DI, Thomas E, Jha RK, Godara NR, Patel NJ. Indian J Comm Health. Youth Tobacco Survey
among the School Going Adolescents in a Block of Vadodara District, Gujarat. 2018; 30, 3: 267-272.
Source of Funding: Nil Conflict of Interest: None declared
Article Cycle
Received: 07/08/2018; Revision: 24/09/2018; Accepted: 28/09/2018; Published: 30/09/2018
This work is licensed under a Creative Commons Attribution 4.0 International License.
Abstract
Background: Tobacco use is the leading cause of Preventable death, Tobacco use during adolescence increases
the risk of persistent addiction, leading to regular and sustained tobacco use in adulthood. Objective: To assess
the prevalence and practice of tobacco use among the school going adolescents in a block of Vadodara district,
Gujarat. Material & Methods: Multiphase sampling was done to select the sample students (13 to 17 years) from
private and government schools in a selected block of Vadodara. A cross-sectional study including 1045 students
was carried out using a pre-designed and pre-tested proforma. Results: Out of 1045 students, 3% (n=32) tried
cigarette smoking ever, one or two puffs and 1.8% (19 students) of students were current cigarette or beedi
smokers. Around 27.9% students and 23% students admitted that at least one of their parents and friends smoked
cigarettes, respectively. About 24% and 44% of the students were exposed to passive smoking at home and
outside home, respectively. Conclusions: Present study provides the baseline information of prevalence of
smoking and attitude of school going adolescents towards smoking in Gujarat. The result gives an alarm to work
upon tobacco control among adolescents and make them aware about the hazards.
Keywords
Smoking; Adolescents; Tobacco
Introduction diseases are directly attributable to tobacco
consumption. (3)
Tobacco kills more than 7 million people every year.
Adolescents (10–19 years) constitute about one-fifth
(1) Tobacco use related diseases results in nearly 8 to
of India’s population. (4) The prevalence of tobacco
9 lakh deaths every year in India. (2) Majority of the
use among the youth population (age 15-24 years)
chronic lung diseases, cancers and cardiovascular
reduced from 18.4 % in GATS-1 (2009-10) to 12.4 %
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INDIAN JOURNAL OF COMMUNITY HEALTH / VOL 30 / ISSUE NO 03 / JUL - SEP 2018 [Youth Tobacco Survey…] | Patel GM et al
in GATS-2 (2016-17). (5, 6) But absolute number of in the classroom from each relevant classes of the
adolescents exposed to tobacco use is still higher. schools, next day, to safeguard the anonymity of the
Adolescence and early adulthood, (ages 15-24 years) subjects.
is the most susceptible time for initiating tobacco use The national prevalence rate for the use of tobacco
in India and it has long lasting health impact on among the youth is 9.6% (2009). The sample size
future life. (7). In India, approximately 5500 children formula n=(Z2*P(1-P))/d2 was used; where
and adolescents start using tobacco products daily, Prevalence P=9.6%, Standard Normal Variate Z=1.96,
majority of users have first tried tobacco prior to age and Precision d=2%. Accordingly, sample size was
18. (8) calculated to be 834 which was rounded off to 1050
In order to facilitate the implementation of the students for the study after taking into account the
tobacco control laws, bring about greater awareness 25% of nonresponse rate of the school students. Out
regarding harmful effects of tobacco and fulfil of all the secondary and higher secondary schools
obligation(s) under the WHO Framework Convention located in Waghodia Taluka multi-phased sampling
on Tobacco Control (WHO FCTC), (9) the was done at school level and student level. The
Government of India launched the National Tobacco schools were divided into two groups i.e. Govt.
Control Programme (NTCP) in the country in 2007- schools and Private schools. Further, there were
08. groups within these schools of male and female. The
The GYTS is a school-based survey designed to selection of the schools and the number of male and
enhance the capacity of countries to monitor female students was done using proportionate
tobacco use among youth and to guide the sampling.
implementation and evaluation of tobacco Inclusion criteria: All the students (both male and
prevention and control programmes. (10) So, female) in the age group of 13 to 17 years who gave
present study used GYTS tool for assessment of the consent for the study were included as study
tobacco prevalence and factors associated among subjects.
the school going adolescents. Exclusion criteria: Those not consenting for the
Aims & Objectives study and those who are out of the age group were
not included as subjects in the study.
To assess the prevalence and practice of tobacco use
Before starting data collection necessary
among the school going adolescents (13-17 years) in
permissions were sought from Institutional Ethics
a block of Vadodara district, Gujarat.
Committee for Human Research and District
Material & Methods Education Office.
The study was conducted during January to August The data was entered in Microsoft Excel 2016 and
2016. A cross-sectional study was carried out using a analysed in SPSS 24.0. Frequency and percentage
pre-designed and pre-tested proforma of National was calculated
Youth Tobacco Survey. (11) Prior written permission Results
was taken from the Education Officer of the
After the cleaning and validation of data, 1045
Vadodara district and also from the respective
entries were recorded into the final database. Out of
Principals and Head Teachers of the selected schools.
1045 students, 19%, 77.9% and 3.1% were in the age-
The questionnaire was explained prior to handing
group 11-13 years, 14-16 years and 17 years or more,
them out to the students. Only those who voluntarily
respectively. Around 58.5% were males and 41.5%
agreed and gave the verbal consent was included in
were females.
the study. The data collected from the subjects using
History of smoking – Out of 1045 students, 3% (n=32)
the questionnaire contained questions on use of
tried cigarette smoking, one or two puffs ever. Out
tobacco, knowledge & attitude towards tobacco,
of 32 students, 10 students had tried smoking even
exposure to other people smoking, attitude towards
before 10 years of age; 12 students had tried
stopping smoking, knowledge about media
smoking at the age of 10 to 13 years; and 10 students
messages about smoking, discussion of smoking in
after 14 years of age.
school, etc. The questionnaire contained multiple
Current smoking status – About 1.8% (n=19) of
response questions with only one option to be
students were current users of tobacco. Out of these
selected. The response sheet did not have any name
19 students, 12 were also using other forms of
on it and it was confidentially collected in a box kept
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INDIAN JOURNAL OF COMMUNITY HEALTH / VOL 30 / ISSUE NO 03 / JUL - SEP 2018 [Youth Tobacco Survey…] | Patel GM et al
tobacco products e.g. chewing tobacco, gutka, sniff, and 44% of the students were exposed to passive
pan masala, etc. (current smoking/chewing was smoking in their house and outside their house,
defined as having smoked/chewed for one or more respectively. Almost half of the students were in
days in last 30 days preceding the survey). favour of ban of smoking cigarettes in closed public
Frequency of smoking – Out of the 32 students who places.
had used tobacco ever – during the past one month Exposure to the media messages on smoking – Out
– 13 students did not smoke, 14 students smoked of 1045 students, during the past one month, 72% of
less than 10 days as compared to 5 students who students were directly exposed to anti-smoking
smoked 10 to 20 days in last month. media messages like television, radio, posters,
Source and expenditure on smoking cigarettes – newspapers, movies, etc. When watching videos,
Out of 19 students who were current tobacco users movies, or television, almost 71% students noticed
(current smoking/chewing was defined as having the actors smoking. About 65% of students saw
smoked/chewed for one or more days in last 30 days billboards with Ads on cigarettes during the last one
preceding the survey) – 9 students bought the month.
cigarettes from a store or a shop, 5 students gave Awareness by Health Education on smoking and its
someone else money to buy them and 5 students got harmful effects – Out of 1045 students, during the
them by other ways. Out of 19 students, 14 spend current school year, about 51% of students agreed to
less than Rs.20 for cigarettes or they were not have discussed about the dangers of smoking with
spending from their pockets for the cigarettes; 3 teachers or classmates in the school premises. About
students spend around Rs.30 to 100 while 2 students 57% of students never had discussion on smoking
spend more than Rs.100 for cigarettes. Out of 19 and health in their classroom as a part of their lesson.
students, 8 admitted that the shopkeeper refused to Only 59.2% students had discussion about the
sell them cigarettes because of younger age while 4 harmful effects of smoking cigarettes at home by
students got the cigarettes from shopkeeper even if their family.
they were young (Table-1). Discussion
Family and friends smoking history – Out of 1045
Tobacco use can risk the lifelong health and may
students, 3.7% students admitted that both their
contribute to non-communicable diseases and to
parents smoked cigarettes while 24.2% students had
early mortality. WHO estimates that India will have
their single parent smoking. Around 23% students
the fastest rate of rise in deaths due to tobacco in the
admitted that at least one of their friends smoke
first 20 years of the 21st century. Because of
cigarettes. Out of 1045 students, 4.3 % admitted that
acquired addiction in early life, most of these deaths
his/her boyfriend or girlfriend is currently smoking.
will be in productive years of life (2).
Attitude towards smoking – Out of 1045 students,
This study provided the baseline data on prevalence
almost 97% of students disagreed to accept the offer
and practice of tobacco use among the school going
to smoke cigarettes even if it was from their best
adolescents (13-17yrs) of Waghodia taluka.
friend/ friends; also similar percentage of students
According to this study, prevalence of smoking is 3%
disagreed to the chances of smoking in the next 1
in the area whereas 1.8% are current smokers.
year or 5 years.
Tobacco is also used in other forms by 1.1% of
About 28% and 19% of students felt that smoking
subjects. According to a report on tobacco control in
helps boys and girls look attractive, respectively.
India, current smoking in India was reported by 8.3%
Around 60% students think that smoking helps in
of adolescents. It ranged from 2.2% in Himachal
losing weight while 34% thinks it has no effect on
Pradesh to 34.5% in Mizoram by different study
weight. About 3 out of 4 students agreed that
results (Figure-1) (2).
smoking is harmful. Half of the students felt that a
A study by Pednekar M, reported that use of tobacco
person who smokes is stupid while around 5% of
among parents and peer has significant influence on
students felt smokers are successful or intelligent
current adolescent smokers (12). Prevalence of
(Table-2). About 35% of students thought that to quit
tobacco use among parents was reported 2 to 3
smoking is difficult.
times higher among smokers and use among peers
Exposure to Second Hand Smoke (SHS) – Out of
was reported 5 to 7 times higher among smokers as
1045 students, about 75% of students believed that
compared to never users (13). Similarly, in our study
smoke from others’ cigarettes is harmful. About 24%
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INDIAN JOURNAL OF COMMUNITY HEALTH / VOL 30 / ISSUE NO 03 / JUL - SEP 2018 [Youth Tobacco Survey…] | Patel GM et al
history of smoking among parents is 2 times higher Health education and information regarding smoking
and history of smoking among peers is almost 3 and its harmful effect can play a major role in delay
times higher among smokers as compared to never or decrease prevalence of smoking if taught to the
users. There was a significant association between students as a part of curriculum. In present study
history of smoking among parents and friends with around half of the student had never discussed the
current use of cigarettes among smokers (p<0.05) in harmful effects with their peer or teachers. Similarly,
present study. Many such influencing factors in our about half of all students agreed that they had been
study as well as past studies showed a strong taught about the dangers of smoking (ranging from
association with tobacco use among adolescents for 2.7% in Bihar to 75.5% in Punjab) (2). Tobacco-use
example positive history of parental and peer outcomes could be improved by school-based
tobacco use, lack of knowledge on harmful effects of education interventions, and cessation assistance
tobacco, positive attitude for the person using and it could be facilitated by training for health
tobacco, etc. (7,9,14). professionals and school teachers for better
During the past 30 days, 72% of students were implementation (18)
directly exposed to anti-smoking media messages Conclusion
like television, radio, posters, newspapers, or movies
Present study provides the baseline information that
in the study. Madan et al reported that almost
number of adolescents started smoking and using
everyone were exposed to cigarette advertisements
other tobacco products from their youth. Higher
on TV, whereas about half reported exposure to
number of students, around one fourth and half of
advertisements from outdoor hoardings (45.7%),
the students were exposed to passive smoking in
newspapers (65.3%) and social events (67.4%) (13).
their house and outside their house, respectively.
An advertisement related to tobacco and smoking is
Study result also shows that many students still have
banned under The Cigarettes and Other Tobacco
positive attitude towards smoking and they are at
Products (Prohibition of Advertisement and
risk of starting smoking in future.
regulation of Trade and Commerce, production,
Supply and Distribution) Act, 2003. To decrease the Recommendation
prevalence of smoking among adolescents as well as The finding underscores the need to strengthen
adults the act should be implemented vigorously. implementation of existing tobacco control rules and
Globally, more than a third of all people are regularly regulations as well as to add some new school-based
exposed to the harmful effects of smoke. This intervention to develop proper attitude among
exposure is responsible for about 600,000 deaths per youth towards tobacco and smoking.
year, and about 1% of the global burden of disease Limitation of the study
worldwide (15). In present study around one fourth
and half of the students were exposed to passive In present study, questionnaire was self-
smoking in their house and outside their house, administered by school going students. In India,
respectively. Pantip et al reported that around tobacco use by adolescents is culturally not
33.8%, 47.9% and 38.6% students were exposed to acceptable, so answer may be under reported or
second hand smoke, respectively at home, school over reported about their knowledge, attitude and
and public places (16). In a study done among school practice. Still this study provides valuable data
children in Mumbai, 16.5% and 39.9% of students regarding tobacco use and its determinants
were exposed to second hand smoke at home and Relevance of the study
outside their homes respectively (17). Government Present study provides the baseline information of
of India adopted legislations for banning smoking in prevalence of smoking and attitude of school going
public places in 2008; with this intervention adolescents towards smoking in Gujarat.
proportion of youth exposed to second hand smoke
Authors Contribution
should decrease. Smoking is banned in many public
places and workplaces such as healthcare, All authors have contributed equally in this study.
educational, and government facilities and on public Acknowledgement
transport; still high number of adolescents are All the schools, DEO and students for their kind
exposed to SHS and needs to be protected. support and cooperation.

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11. Centers for Disease Control and Prevention (CDC-USA).
References National Youth Tobacco Survey (NYTS). 2014.
1. World Health Organization. (2018). Tobacco. [online] 12. Pednekar MS, Gupta PC. Tobacco use among school
Available at: http://www.who.int/news-room/fact- students in Goa, India. Indian J Public Health. 2004 Jul-
sheets/detail/tobacco [Accessed on 10/10/18]. Sep;48(3):147-52. PubMed PMID: 15709603.[PubMed].
2. Shrinath R, Prakash G. Report on Tobacco Control in India, 13. Madan Kumar PD, Poorni S, Ramachandran S. Tobacco use
Ministry of Health & Family Welfare. 2004. among school children in Chennai city, India. Indian J
3. Gajalakshmi V, Peto R, Kanaka T, Jha P. Smoking and Cancer. 2006 Jul-Sep;43(3):127-31. PubMed PMID:
mortality from tuberculosis and other diseases in India: 17065771.[PubMed].
retrospective study of 43000 adult male deaths and 35000 14. Gajalakshmi V, Asma S, Warren CW. Tobacco survey among
controls. Lancet (London, England). 2003 youth in South India. Asian Pac J Cancer Prev. 2004 Jul-
Aug;362(9383):507–15. Sep;5(3):273-8. PubMed PMID: 15373706.[PubMed].
4. Strategy Handbook; Rastriya Kishor Swasthya Karyakram, 15. World Health Organization. (2018). Tobacco. [online]
Ministry of Health and Family Welfare, Nirman Bhavan, Available at: http://www.who.int/news-room/fact-
New Delhi. 2014. sheets/detail/tobacco [Accessed on 12/09/18].
5. Global Adult Tobacco Survey: India 2009-10 Report, 16. Chotbenjamaporn P, Haruhansapong V, Jumriangrit P,
Ministry of Health and Family Welfare, Government of Pitayarangsarit S, Agarwal N, Garg R. Tobacco use among
India, New Delhi. thai students: Results from the 2015 global youth tobacco
6. Global Adult Tobacco Survey: India 2016-17 Report, survey. Indian J Public Health [Internet]. 2017 Sep
Ministry of Health and Family Welfare, Government of 1;61(5):40–6.
India, New Delhi. 17. Raute LJ, Pednekar MS, Mistry R, Gupta PC, Pimple SA,
7. Assessment of pattern, profile and correlates of substance Shastri SS. Determinants of exposure to second-hand
use among children in India, National Commission for smoke at home and outside the home among students aged
Protection of Child Rights (NCPCR), New Delhi. 2013. 11-17 years: results from the Mumbai Student Tobacco
8. Patel DR. Smoking and children. Indian J Pediatr. 1999 Nov- Survey 2010. Indian J Cancer. 2012 Oct-Dec;49(4):419-24.
Dec;66(6):817-24. PubMed PMID: 10798145.[PbuMed]. doi: 10.4103/0019-509X.107750. PubMed PMID:
9. WHO Framework Convention on Tobacco Control, 5. World 23442407.[PubMed].
Health Organization. Geneva; 2003. 18. McKay AJ, Patel RK, Majeed A. Strategies for tobacco
10. World Health Organization. (2018). Global youth tobacco control in India: a systematic review. PLoS One. 2015 Apr
survey (GYTS). [online] Available at: 9;10(4):e0122610. doi: 10.1371/journal.pone.0122610.
http://www.who.int/tobacco/surveillance/gyts/en/ eCollection 2015. PubMed PMID: 25856462; PubMed
[Accessed 09/06/18]. Central PMCID: PMC4391913.[PubMed]
Tables
TABLE 1 DISTRIBUTION OF STUDENTS ACCORDING TO SOME INFLUENCING FACTORS (N=32)
Influencing factors (n=32)
Access-Not refused to sell because of their age 4 (12.5%)
Using other tobacco products along with cigarettes 12 (37.5%)
Parents smoked 16 (50 %)
Friends smoked 23 (71.9%)
Know harmful effects 19 (59.4%)
Discussed harmful effect with friends 15 (46.9%)
Discussed harmful effect at school 14 (43.8%)
Exposed to anti-smoking media message 23 (71.9%)
TABLE 2 DISTRIBUTION OF STUD ENTS ACCORDING TO THEIR ATTITUDE TOWARDS SMOKING
Attitude factors (n=1045) Yes (%) No (%) No difference (%)
Chances of smoking in 5 years from now 3.0 97.0 -
Is it difficult to quit smoking? 35.2 64.8 -
Smoking helps boys to have more friends? 18.1 58.4 23.5
Smoking helps girls to have more friends? 13.5 60.3 26.2
Smoking helps in feeling comfortable in social gatherings 22.7 40.1 37.2
Smoking helps boys look attractive? 27.8 42.7 29.5
Smoking helps girls look attractive? 18.8 52.0 29.2
Does smoking help in gain weight? 6.0 59.9 34.1
Is smoking harmful to your health? 74.6 25.4 -
Having positive thoughts for the man who smokes 4.9 95.1 -
Having positive thoughts for the woman who smokes 4.8 95.2 -
Smoking only for a year or two and then quitting, is it safe? 31.2 68.8 -

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Figures
FIGURE 1 PREVALENCE OF CURRENT SMOKERS BY DIFFERENT STUDIES AT DIFFERENT PLACES (%)

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