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Year : 2020  |  Volume : 13  |  Issue : 4  |  Page : 389-393  

Correlates of knowledge and consumption of tobacco in adolescent males of an Urban Slum in Western Maharashtra

Department of Community Medicine, AFMC, Pune, Maharashtra, India

Date of Submission23-Dec-2019
Date of Decision24-Dec-2019
Date of Acceptance03-Mar-2020
Date of Web Publication20-Jul-2020

Correspondence Address:
Vikram Singh Grewal
Department of Community Medicine, AFMC, Pune, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_258_18

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Context: Tobacco use is the forerunner among the most serious public health issues threatening the world. Problem is compounded by the fact that most of tobacco users indulge in tobacco from adolescence. More than one-fourth of young men in India consume tobacco. The National Health Policy 2017 aims to reduce the prevalence of tobacco usage by 15% by 2020. To achieve this goal, the youth must be targeted to abstain from tobacco. Aim: To study the correlates of the knowledge and consumption of tobacco in adolescent males. Settings and Design: This was a cross-sectional study in a school in an urban slum in Western Maharashtra. Methodology: The study was conducted in a school in an urban slum on 394 adolescent males using pretested self-administered questionnaire. All the participants gave assent. Ethical permission from the institutional ethics committee was taken. Statistical Analysis Used: Percentages and Pearson's Chi-square test were done using SPSS 20. Results: The proportion of adolescents having knowledge about hazards of tobacco was 65.2%, while the prevalence of tobacco use was 24.4%. Tobacco usage was found to be significantly associated with the usage in family; paradoxically, the adolescents who witness tobacco use at home were more likely to have knowledge about hazards of tobacco. Knowledge about harms of tobacco use was found to be significantly associated with educational status of mother. Conclusion: Important correlates of knowledge about hazards of tobacco usage were the type of family, maternal education, as well as usage of tobacco in family.

Keywords: Adolescent health, school health, tobacco, urban slum

How to cite this article:
Kumar S, Grewal VS, Dudeja P, Kaushal N, Gadekar T. Correlates of knowledge and consumption of tobacco in adolescent males of an Urban Slum in Western Maharashtra. Med J DY Patil Vidyapeeth 2020;13:389-93

How to cite this URL:
Kumar S, Grewal VS, Dudeja P, Kaushal N, Gadekar T. Correlates of knowledge and consumption of tobacco in adolescent males of an Urban Slum in Western Maharashtra. Med J DY Patil Vidyapeeth [serial online] 2020 [cited 2020 Nov 24];13:389-93. Available from: https://www.mjdrdypv.org/text.asp?2020/13/4/389/290173

  Introduction Top

Tobacco use is one of the most serious public health threats worldwide. Annually, six million people die due to tobacco as per the WHO.[1] Tobacco usage, especially tobacco smoke, has been implicated for a variety of cancers. The International Agency for Research on Cancer has listed more than 70 carcinogens present in tobacco smoke.[2] The proportion of Indian men aged 15 years and above using tobacco is 48%, with half of them smoking tobacco.[3] It has been found that more than one-fourth of young men (aged 15–24 years) in India consume tobacco.[4]

Tobacco use in students has found to be associated with poor academic performance.[5] Adolescent boys face a lot of stressors in the form of changing physical appearance, comparisons among boys and violence at home or school, as well as parental problems. These stressors coupled with the increased autonomy and risk-taking behavior makes them most vulnerable for tobacco initiation. As per the Global Adult Tobacco Study (GATS), 40.4% of those using tobacco initiate tobacco use before the age of 17 years in India, when ironically the sale of cigarettes and other tobacco products to minors under 18 years of age is prohibited under the Cigarettes and Other Tobacco Products Act (COTPA) of 2003. The act also prohibits smoking in public places as well as bans sale of tobacco products within 100 yards of all educational institutions and has made it mandatory to display pictorial fatal health warnings on tobacco products packages.[6],[7] However, this reduction is far less considering the goal set by the National Health Policy 2017, which is to reduce tobacco usage by 15% by 2020.[8] To achieve the set targets, it is crucial to study the factors associated with adolescent smoking. Adolescent tobacco use has complex and multifactorial causes.[9],[10] Aside from the factors of stress, socioeconomic status, peer tobacco use, role of family members, as well as their education level need more research.

Although some studies regarding tobacco use in adolescents have been conducted, the literature is inadequate when it comes to role of family support system, especially the mother and siblings. As per the GATS 2009–2010, the prevalence of tobacco use among young men aged 15–24 years is more than three times than that of young women of the same age. There is 32-fold prevalence of smoking in males of the same age group as compared to females.[4] Therefore, the present study was planned with a primary aim to ascertain the prevalence and other factors associated with tobacco use among adolescent males.

  Methodology Top

The present cross-sectional study was conducted in a government school in an urban slum (field practice area) in Western Maharashtra. The prevalence of awareness and use of tobacco as 50% was taken for the purpose of sample size calculation. The sample size so calculated was 384; however, a total of 394 willing male students aged 10–19 years were included. Assent was taken from all the participants. Sampling fame was available in the form of a list of male students from the class teachers. All male students from Class VI–IX were included in the study. Ethical permission from the Institutional Ethics Committee (IEC) of Armed Forces Medical College, Pune, was taken, vide letter number IEC/2019/362 dated December 21, 2019. A self-administered questionnaire was pretested in a pilot study. It covered information on demographic characteristics; tobacco use in any form, age at initiation, and influence of media/family members and friends. After each data collection session, children were imparted knowledge on hazards of tobacco consumption. Data were compiled and analysis was done using SPSS 20 (IBM Statistics, Bangalore, Karnatka, India). Percentages were calculated and Pearson's Chi square test was applied.

  Results Top

A total of 394 adolescent males participated and completed the questionnaire. Nearly half of the respondents were in the age group of 10–13 years while the other half in the age group of 14–19 years. The proportion of students having knowledge about hazards of tobacco was 257 (65.2%). Television and radio were found to be the leading sources of information [Figure 1]. Educational status of mother and tobacco use in family along with its frequency were significant correlates with the knowledge about tobacco hazards [Table 1].
Figure 1: Source of information on hazards of tobacco. This is a pie chart depicting sources of information on hazards of tobacco. Out of total 394 participants, 137 (34.77%) were unaware about hazards of tobacco, while 38 (9.64%) chose not to respond to this question

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Table 1: Variables affecting knowledge about hazards of tobacco

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The prevalence of tobacco consumption in adolescent males was found to be 24.4%. Curiosity to try something new and failed relationships with opposite sex were cited among the main causes of initiation of tobacco, followed by stress and failure in academic examinations [Figure 2]. Variables significantly associated with tobacco use were the type of family and tobacco use in family [Table 2]. Among the 96 tobacco users, only 60 were aware of its health hazards. Nearly half (52.8%) of the participants responded in affirmative when asked about availability of tobacco products with vendors near the school with 54 out of 96 tobacco users having purchased tobacco products from vendors near the school. Use of smokeless tobacco was more prevalent as compared to smoked tobacco. Majority of tobacco users (71.9%) used pan masala/gutka, while cigarette and beedi were used by 8.3% and 19.8% tobacco users, respectively.
Figure 2: Reason for initiation of tobacco among adolescent tobacco users. Out of 96 tobacco users, 9 (9.37%) initiated tobacco due to curiosity and another 9 (9.37%) due to peer pressure

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Table 2: Variables affecting tobacco use

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  Discussion Top

The prevalence of tobacco use found in our study is considerably high as compared to 12.4% in the GATS 2016–2017 (GATS 2). The difference in prevalence may be due to different age structures of the study population as well as the fact that our study population was from urban slum while the study population of GATS 2 was heterogeneous.[11] Majority of the respondents had knowledge about hazards of tobacco usage, with television and cinema being the largest contributor to this knowledge. This is consistent with the studies done in the western world regarding the effect of anti-tobacco advertisements.[12] The political will to implement provisions of the COTPA seems to be paying the dividend as evident from the fall in tobacco consumption in GATS 2 report as compared to GATS 2009–2010 (GATS 1). India has registered a 6% decrease in the prevalence of tobacco consumption from 34.6% in 2009–2010 in GATS 1%–28.6% in 2016–2017 in GATS 2.[6],[11]

To our knowledge, it is the first study to find association of maternal education in knowledge about tobacco hazards as well as tobacco use by adolescents in the country. In spite of extensive literature search, we could not find any studies relating maternal education to tobacco consumption of adolescents in India. The awareness improved with increasing maternal education, but at the same time, the prevalence of use too increased. The increase in the prevalence of use was not significantly associated with maternal education and could be by chance.

Du et al., in a study conducted on multicultural students in Hawaii, found association of parental education with smoking among adolescents.[13] Adolescents of educated mothers were more knowledgeable about hazard of tobacco usage and less were less likely to use tobacco in any form as compared to adolescents of mothers uneducated or less educated. The association of mother's education with nutritional status of children has been studied already.[14] This revelation is significant from public health perspective as well as for women empowerment. Thus, educating the girl child has got many potential benefits for humankind. Far greater gains in anti-tobacco programs can be made by involving mothers in the program. The policymakers may consider this role of mothers and enhance the same for a more effective anti-tobacco campaign.

Our study also disclosed the association of family structure with the knowledge. Adolescents from nuclear families were better educated regarding knowledge of tobacco hazards; however, the usage of tobacco was lower among adolescents from joint families. The better supervision mechanism in the joint family, due to the presence of many elders in addition to parents, seems to have a better check on the behavior of the adolescents. We could not find any relevant Indian studies on this aspect.

Half of ever tobacco users consumed smokeless tobacco mostly in the form of khaini/gutka; only a few smoked cigarettes. GATS 2016–2017 (GATS 2) report collaborates with this; the number of adults smoking tobacco is less than half of those using smokeless tobacco.[11] This can be due to relatively low price of khaini/gutka as compared to cigarette and convenience to conceal the usage as there is no smoke or smell which can get them caught by parents/teachers. The low cost of smokeless tobacco is because of relative neglect of this form of tobacco for tobacco taxation. As per the Tobacco Institute of India, tobacco taxation in India is levied almost entirely on cigarettes, and per kilogram taxation on cigarettes is Rs. 4159/- as compared to Rs. 81/- on other tobacco products.[15] The Ministry of Health and Family Welfare report on tobacco taxes in India is also focused on cigarettes and beedis, while smokeless tobacco misses the attention it deserves.[16] It is time when policymakers must raise the tobacco taxes on smokeless tobacco products as well as it has been proven to be the single most effective measure to reduce tobacco consumption.[17]

  Conclusion Top

In the present cross-sectional study, the prevalence of ever use of tobacco was 24.6% among adolescents in an urban slum. More than half of the tobacco users were using smokeless forms of tobacco. Important correlates of knowledge about hazards of tobacco usage were the type of family, maternal education, as well as usage of tobacco in the family. Cinema and television were appreciated to be the major sources of this knowledge; the anti-tobacco advertisements seem to be hitting the right spot.

There were similar factors in play with respect to the use of tobacco. Educating and involving mothers in anti-tobacco campaigns can be a novel tool in securing tobacco-free youth; however, more studies may be needed in this respect before any policy design is taken. Youth as the prime resource of the nation needs to be safeguarded from maladies like tobacco and its associated health impact; an exclusive youth-oriented anti-tobacco media campaign is need of the hour.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

World Health Organization. WHO factsheet on tobacco. Available from: http://www.who.int/mediacentre/factsheets/fs339/en/. [Last accessed on 2018 May 11].  Back to cited text no. 1
World Health Organization. International Agency for Research on Cancer (IARC) Monographs on the Evaluation of Carcinogenic Risks to Humans Volume 83. Tobacco Smoke and Involuntary Smoking; 2004. Available from: https://monographs.iarc.fr/wp-content/uploads/2018/06/mono83.pdf. [Last accessed on 2018 May 14].  Back to cited text no. 2
The GATS Atlas. The GATS Collaborative Group. Available from: http://gatsatlas.org/downloads/GATS-whole-book-12.pdf. [Last accessed on 2018 May 21].  Back to cited text no. 3
Global Adult Tobacco Survey, Fact Sheet India 2009-10. Available from: http://www.who.int/tobacco/surveillance/en_tfi_india_gats_fact_sheet.pdf. [Last accessed on 2018 May 25].  Back to cited text no. 4
Mekonen T, Fekadu W, Chane TM, Bitew SW. Substance use as a strong predictor of poor academic achievement among university students. Psychiatry J 2017. doi.org/10.1155/2017/7517450.  Back to cited text no. 5
Global Adult Tobacco Survey, India 2009-10. Available from: http://www.searo.who.int/tobacco/documents/2010-pub2.pdf. [Last accessed on 2018 May 27].  Back to cited text no. 6
The Gazette of India No 37/2002. The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act; 2003. Available from: http://www.who.int/fctc/reporting/Annexthreeindia.pdf. [Last accessed on 2018 May 31].  Back to cited text no. 7
Ministry of Health and Family Welfare, Government of India. National Health Policy; 2017. Available from: https://mohfw.gov.in/documents/policy. [Last accessed on 2018 Jun 17].  Back to cited text no. 8
Singh G, Sinha DN, Sarma PS, Thankappan KR. Prevalence and correlates of tobacco use among 10-12 year old school students in Patna District, Bihar, India. Indian Pediatr 2005;42:805-10.  Back to cited text no. 9
Ladusingh L, Dhillon P, Narzary PK. Why Do the Youths in Northeast India Use Tobacco? J Environ Public Health 2017;2017:1-6.  Back to cited text no. 10
Ministry of Health and Family Welfare Government of India. GATS-2 India 2016-17 – Factsheet; 2017. Available from: https://www.mohfw.gov.in/sites/default/files/GATS-2%20FactSheet.pdf. [Last accessed on 2018 Jun 20].  Back to cited text no. 11
Pechmann C, Reibling ET. Anti-smoking advertising campaigns targeting youth: Case studies from USA and Canada. Tob Control 2000;9 Suppl 2:II18-31.  Back to cited text no. 12
Du Y, Palmer PH, Sakuma KL, Blake J, Johnson CA. The association between family structure and adolescent smoking among multicultural students in Hawaii. Prev Med Rep 2015;2:206-12.  Back to cited text no. 13
Abuya BA, Ciera J, Kimani-Murage E. Effect of mother's education on child's nutritional status in the slums of Nairobi. BMC Pediatr 2012;12:80.  Back to cited text no. 14
The Tobacco Institute of India; Tobacco Consumption; 2017. Available from: http://www.tiionline.org/facts-sheets/tobacco-consumption/. [Last accessed on 2018 Jul 18].  Back to cited text no. 15
Ministry of Health and Family Welfare Government of India. Tobacco taxes in India: An empirical analysis. Available from: http://www.searo.who.int/india/topics/tobacco/highlights_of_tax_affordability_study7jan_final.pdf?ua=1. [Last accessed on 2018 Jul 12].  Back to cited text no. 16
Jha P, Chaloupka FJ. The economics of global tobacco control. BMJ 2000;321:358-61.  Back to cited text no. 17


  [Figure 1], [Figure 2]

  [Table 1], [Table 2]


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