|Year : 2015 | Volume
| Issue : 1 | Page : 24-29
Prevalence of tobacco use among 15-20 years old college students in Bengaluru city
Vasudha Sharma1, SS Hiremath2, Manjunath Puranik3, Shweta Somasundara1
1 Department of Public Health Dentistry, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India
2 Department of Public Health Dentistry, Oxford Dental College and Hospital, Bengaluru, Karnataka, India
3 Department of Public Health Dentistry, Government Dental College and Research Institute Dental College and Hospital, Bengaluru, Karnataka, India
|Date of Web Publication||19-Mar-2015|
Dr. Vasudha Sharma
Department of Public Health Dentistry, Rajarajeswari Dental College and Hospital, No. 207, Kambipura, Kumbal Godu, Mysore Road, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Tobacco use in children and adolescents is reaching pandemic levels. The World Health Organization predicts that India will have the fastest rate of rise in deaths attributable to tobacco in the productive years of adult life, as a consequence of an addiction acquired in youth. Materials and Methods: A cross-sectional questionnaire study based on global youth tobacco survey was undertaken to study the prevalence of tobacco use among 15-20 years old college students. A simple random sampling method was used to select the students from Government and Private schools and Colleges in Bengaluru city. Results: In the study population of 2399 in the age group of 15-20 years, 307 (12.8%) subjects reported use of cigarettes among whom 176 (7.3%) reported current use and 240 (10%) reported ever use of smokeless tobacco. Majority 226 (73.6%) belonged to private institutions and 81 (26.4%) to government institutions. About 41 (1.7%) were daily smokers. Conclusion: Prevalence of smoking was much higher among the private institution students as opposed to students of government institutions; also, it was observed that the percentage of smokeless tobacco users were higher in this age group when compared to cigarette smokers.
Keywords: Global youth tobacco survey, smokeless tobacco use, tobacco use
|How to cite this article:|
Sharma V, Hiremath S S, Puranik M, Somasundara S. Prevalence of tobacco use among 15-20 years old college students in Bengaluru city. J Indian Assoc Public Health Dent 2015;13:24-9
| Introduction|| |
Tobacco use is a serious public health challenge in several regions of the world. According to estimates made by the World Health Organization (WHO), currently about 5 million people die prematurely every year in the world due to the use of tobacco, mostly cigarette smoking. By 2030, it would double to 10 million deaths every year, with about 7 million of the deaths taking place in developing countries. India will have the fastest rate of rise in deaths attributable to tobacco and many of these will occur in the productive years of adult life, as a consequence of an addiction acquired in youth. 
The global literature is only of limited help in assessing the problem of tobacco use in India since the dominant and the most researched form of tobacco use globally is cigarette smoking. In India, cigarette smoking comprises a small part of the tobacco smoking problem and a minor part of the overall tobacco problem, a major problem being beedi smoking, and the oral use of smokeless tobacco products. Adolescents are the most vulnerable population to initiate tobacco use. However, it is now well established that most of the adult users of tobacco start tobacco use in childhood or adolescence. 
Many studies across the world and in the country have focused on 13-15 years age group using global youth tobacco survey (GYTS) while global adult tobacco survey has been used for adult population. The present study was an attempt to specifically study the pattern tobacco use both smoking and smokeless forms among the 15-20 years old as 15 years is a transition age group from school to college, which offers more freedom than rigid school systems and 17 years is transition from junior college to senior college in our country. However, very few studies have been conducted with respect to prevalence of use of tobacco in any form among especially college going students in our country. Hence, the aim of the study was to assess the prevalence of smoking and smokeless tobacco use among 15-20 years old college students in Bengaluru city.
| Materials and Methods|| |
This was a cross-sectional questionnaire-based study conducted on 15-20 years old college students in Bengaluru city. List of colleges was obtained from The Directorate of Pre University Education Bengaluru and collegiate education.
Colleges in Bengaluru are divided into north and south zones with 306 colleges in south and 236 colleges in north zone respectively. From north Zone, 4 Government and 1 Private College and from south zone, 3 Government and 3 Private Colleges offering pre university and degree courses were selected randomly until the required sample size was satisfied. The study participants were selected using simple random sampling from I st year, II nd year pre university and I st , II nd and III rd year degree students to suit the age group of the study.
A pilot study was conducted, and the population proportion of tobacco use was estimated at 40%. Based on this, sample size was estimated at 2304 subjects. It was then rounded off to 2400 study subjects.
Ethical clearance was obtained by the institutional ethical committee. Necessary permissions were obtained from Board of Pre-University and collegiate education and the study and colleges. The required permissions to conduct the study were taken from the college authorities.
The study participants were allotted a number and were asked not to disclose their name to protect the confidentiality of the information provided. Demographic information regarding the age, sex, education, parental education level, occupation and socioeconomic status was collected. Information regarding smoking and use of smokeless tobacco among students were ascertained using a questionnaire derived from the GYTS  and modified to suit the present study. The students were asked to assemble in a classroom and explained the purpose of the study. The questionnaire was then administered and was collected after they had completed answering all questions.
Ascertainment of tobacco exposure was done using the terminologies suggested by GYTS. Ever users of cigarettes or ever smokers were defined as those who reported having smoked >100 cigarettes during their lifetime. Current smokers were defined as those who reported having smoked >100 cigarettes during their lifetime and who currently smoked every day or some days. Never smokers were defined as those who reported not having smoked >100 cigarettes during their lifetime. Ever use of tobacco products other than cigarette was defined as having used these products at least 20 times in their life. The category of current smokers in this study included those who reported to be occasional smokers, frequent smoker and daily smokers.
Descriptive statistics was used to analyze the data. Statistical analysis was performed using SPSS version 14 (spss inc. Chicago, USA).
| Results|| |
[Table 1] shows the distribution of participants in different age groups. Of 2400 students, one student did not respond and hence statistical analysis and result reporting was done using the final sample of 2399 students: 1391 (57.9%) belonged to private institution and 1009 (42.04%) to government institutions. About 1366 (57%) were males, and 1033 (43%) were females.
Prevalence of smoking in various groups
Prevalence of ever use
In the study population of 2399, 307 (12.8%) subjects reported ever use of cigarette, 262 (85.3%) were males and 45 (14.9%) were females, 226 (73.6%) belonged to private institutions and 81 (26.4%) to government institutions
Prevalence of current use of cigarettes
In the present study, 176 (7.3%) reported current use of cigarette. Among the 176 students who reported current use, 123 (5.1%) were ex-smokers, 112 (4.7%) were occasional smokers, 23 (1%) were frequent smokers and a total of 41 (1.7%) reported to be daily smokers. Among the 1367 males, 16% reported ever use of cigarette and among the 1033 females, 4.5% reported ever use of cigarette. [Table 2] shows the distribution of current smokers with respect to gender.
Distribution of study population with respect to current use of cigarettes and age
Out of 176 current users of cigarette, 2 (1.1%) students were of the age 15 years; 20 (11.3%) were 16 years old; about 41 (23.2%) were 17 years of age; 48 (27.2%) were 18 years of age; 30 (17%) students were 19 years of age and 35 (19.8%) were 20 years old. Of the 41 subjects who were daily smokers, 1 (2.4%) student was of the age 15 years; 1 (2.4%) was 16 years old; 7 (17.1%) were 17 years of age; 16 (39%) subjects were 18 years of age and 12 (29.3%) were 20 years of age.
Distribution of study population with respect to age, gender and current use of cigarettes
Out of 147 males who were current users of cigarette, 2 (1.3%) students were of the age 15 years, 15 (10.2%) were 16 years old, about 36 (24.4%) were 17 years of age, 37 (24.5%) were 18 years of age, 26 (17.6%) students were 19 years of age and 31 (21%) were 20 years old.
Out of 29 females who were current users of cigarette, 5 (17.2%) were 16 years old, about 5 (17.2%) were 17 years of age, 11 (37.9%) were 18 years of age, 4 (13.7%) students were 19 years of age and 4 (13.7%) were 20 years old.
Distribution of study population with respect to age of initiation of the habit among pre university and degree groups
Among the 307 ever smokers, 89 (28.9%) reported smoking before the age of 15 and 218 (71.1%) reported smoking after the age of 15 years. [Table 3] shows the age of initiation among ever smokers.
|Table 3: Distribution of ever users of cigarettes with respect to age of initiation of the habit and education category |
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Prevalence of use of tobacco products other than cigarettes
Distribution of users of tobacco products other than cigarettes among the pre university and degree group
Among the total population of 2399 students, 240 (10%) of the students have reported ever use of tobacco products like guthka, khaini, snuff, hookah. Among the 240 students who reported ever use, 106 (44.1%) belonged to the pre university category and 134 (55.8%) were degree students.
Among the 176 who reported current use of cigarettes, 51 (28.9%) reported ever use of tobacco products like guthka, khaini, snuff, hookah Furthermore, it was observed that 14 (34%) of the daily smokers reported concurrent ever use of smokeless tobacco and among the students who reported no use of cigarettes, 153 (6.3%) reported use of only smokeless tobacco. [Table 4] shows the distribution of ever users of tobacco products other than cigarettes among students in different college categories. [Table 5] shows the ever use of tobacco products other than cigarettes among students who reported to be current smokers.
|Table 4: Distribution of students reporting ever use of tobacco products other than cigarettes with and education category and college category |
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|Table 5: Distribution of current users of cigarette reporting ever use of tobacco products other than cigarettes with education category and college category |
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| Discussion|| |
Tobacco use is one of the major preventable causes of premature death and disease in the world. The WHO estimated that the proportion of deaths that result from tobacco-related diseases will rise in India, from 1.4% of all deaths in 1990 to 13.3% of all deaths in 2020. In India's case, the population is expected to grow by about 300 million between 2000 and 2020.  Most of the expansion will occur in the age group of 15-20 years.
Prevalence of ever users and current users
In the present study, among the total population, 176 (7.3%) reported current use of cigarettes, 147 (6.1%) males and 29 (1.2%) females reported current cigarette use. A study in Haryana in 1995 among adolescents  and 2002 among college students  reported 7.1%, which is similar to the present study. Whereas, according to GYTS - India 2002-2004,  prevalence of current smoking among students was 8.3%, study among college students in Andhra Pradesh,  prevalence of current smokers was 8.2%, CDC-MMWR  reported 9.2%, Western Nepal 2007  reported 9.4% and in a study in Greece  in 2007, 10.4% students were current smokers. Study in Maharashtra 1998  reported 10.6%, country wide study in 2004  reported 19.4%, Youth tobacco surveillance New York  reported 16.3% and Georgia youth tobacco survey  reported 14% which is much higher, this can be attributed to sociocultural and geographic differences.
Among the 307 ever users, the majority 226 (73.6%) belonged to private institutions and 81 (26.4%) to government institutions, whereas in a study in Chennai in 2006  reported that smoking was more in the corporation students which is not in line with the present study. Similarly, a study in Delhi and Chennai 2004  has reported that the prevalence of ever smoking was 18.9% in government sector when compared to 12.2% in private sector which is again, not in line with this study. Among the 176 current smokers, 132 (72%) belong to private institutions and 44 (18%) belong to government institutions. Of the 41 daily smokers, 25 (60.9%) are from private institutions and 16 (39.9%) are from government institutions. Whereas in a study in Bombay in 1991  reported that 22.5% of the smokers belonged to private English institution when compared to 13.8% in the municipal sector, which is less than the present study.
Age of initiation
In the present study, nearly 29% reported initiation of ever use of cigarette before the age of 15 similar to other studies, however, the age range of initiation spans from as low as 10 years in certain studies to as high as 18. Among the 307 ever users 89 (28.9%) reported smoking before the age of 15 and 218 (71.1%) reported smoking after the age of 15 years whereas in the study in Western Nepal 2007  89.6% of ever smokers had initiated smoking between the ages 12 and 18 years with a median age of 16 years and 30.2% of ever smokers initiated before the age of 15 years. In a study in Uganda 2004,  37.8% had smoked before the age of 10 years. Whereas a study in Harayana in 1995 among adolescents  reported that the majority of smokers had started at the age of 10-15 years and almost 36% had smoked before the age of 10 years. Whereas study in 2002 among college students,  reported that 40% of students, majority males had started the habit between the ages of 10 and 15 years. However, in a study in Karachi 2007  reported that the mean age of starting cigarette in males was 13.1 years.
There has been reporting of different ages with respect to age of initiation in various studies. This may be on account of the various age groups used in these studies and also to the cultural differences in the study populations of these studies. There may be differences also due to the fact that the age of initiation again is self-reported by the participant.
Age of current smokers
Out of 176 current users of cigarette, 2 (1.1%) students were of the age 15 years, 20 (11.3%) were 16 years old, about 41 (23.2%) were 17 years of age, 48 (27.2%) were 18 years of age, 30 (17%) students were 19 years of age and 35 (19.8%) were 20 years old.
On the whole, among the current users, use of cigarettes was seen more in the age group of 17-20 years. However, a study in Alaska 2004  reported than cigarette smoking seems to peak at the ages from 18 to 24 years.
Prevalence of use of tobacco products other than cigarettes
In the present study, the overall prevalence of smokeless tobacco use is about 10%, there was a wide variation of percentage of tobacco products other than cigarettes use, ranging from 10% to as high as 55.6%. According to the GYTS - India 2002-2004,  14.6% were the current smokeless tobacco users ranging from 2% in Himachal Pradesh to 55.6% in Bihar. In the GYTS 2002 in Uttaranchal,  the prevalence was 17.6%, higher than the present study; in a study in Jamnagar 2007,  the prevalence of smokeless tobacco use among 17-19 years age group was 36.26%, much higher than the present study. Maharashtra 1998  study reported 6.7%, A study in Mumbai 2006  reported overall smokeless tobacco use as 10% which is comparable to the present study. In a study in Greece  in 2007, the prevalence of smokeless tobacco use was 10.9%.Whereas, the prevalence of smokeless tobacco in Canada 2004  was 14%. Tobacco use survey in high school students in US  showed the prevalence to be 12.8%, Karachi 2007  was 16.1%. According to Florida youth tobacco survey-2006,  current smokeless tobacco use among high school students is about 6%, Youth Tobacco Surveillance, New York  reported 3.2%, CTUMS Ontario  reported use among 15-19 years old youth as 7%, Western Nepal 2007  study reported 6.5%, which is lower than the present study.
It was also observed that the percentage of smokeless tobacco users was slightly higher in the students from the private institution when compared to government, also was higher among the degree students than pre-university students.
The prevalence of smokeless tobacco use among these students was much higher than use of cigarettes. Some of the reasons for this trend may be that smokeless tobacco consumption can be done more discreetly as there is no associated smoke or odor, can be used inside classrooms. Comparatively more economical compared with cigarettes as a single packet can be used over an entire day. The small pouches can be concealed easily and also easier to hide the habit from family members.
Global youth tobacco survey is limited to students especially in the ages 13-15 years and most of the data are available from sporadic surveys is in this age group. The present study was conducted on age groups 15 through 20 years and hence comparability was limited. Furthermore, in India, there is a huge dropout rate in education after schooling, it is important that tobacco use survey must be extended to those youth who do not attend schools or colleges.
Second, these data apply only to youths who were in college on the day of the survey and who completed the survey. However, student response rates were high suggesting that bias attributable to absence or nonresponse was limited. Finally, data were based on the self-report of students, who might underreport or overreport their behaviors or attitudes. The extent of this bias cannot be determined from these data.
| Conclusion|| |
The gloomy predictions about the growing magnitude of tobacco threat to India relate to a rise both in the proportion of deaths attributable to tobacco and in the absolute number of persons who consume tobacco. The age group of 15-20 encompasses most of the high school/pre university and degree students, which is most vulnerable to acquiring and continuing the tobacco addiction. It was observed in this study among the 176 current smokers, 72% belong to private institutions and 18% belong to government institutions. Of the 41 daily smokers, 60.9% are from private institutions and 39.9% are from government institutions. The prevalence of smoking was much higher in the private institution as opposed to government institutions; this may be attributed to greater financial independence of students in private institutions, prevalent peer pressure. Also, it was observed that the percentage of smokeless tobacco users were higher in this age group as compared to cigarette smokers.
Therefore, it is necessary to monitor the trends in age of initiation as well as the prevalence of tobacco usage patterns in this age group of college going students at the national level. Measures to curb the increasing use of tobacco among the youth have to be enforced more strictly.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]