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ORIGINAL ARTICLE
Year : 2020  |  Volume : 18  |  Issue : 3  |  Page : 246-249

Prevalence of tobacco use and effect of restrictions on smoking at home, at school, and in public places on teenagers in Lucknow City: A cross-sectional study


Department of Public Health Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Submission24-Jan-2018
Date of Decision20-Apr-2018
Date of Acceptance20-Sep-2020
Date of Web Publication24-Oct-2020

Correspondence Address:
Madhuri Kumari
Department of Public Health Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_33_18

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  Abstract 


Background: This study focused on the estimation of the prevalence of tobacco use among school-going students (between the age of 14 and 17 years) and to determine the relation between the extent of restrictions on smoking at home, at school, and in public places. Materials and Methods: A total of 310 school students of Lucknow aged 14–17 years were selected by the convenient sample design. A specifically designed questionnaire was used for determining the relation between the extent of restrictions on smoking at home, at school, and in public places and smoking uptake and smoking prevalence among school students. A cross-sectional survey with merged records of extent of restrictions on smoking in public places was done. The collected data were analyzed and tested for significance using the Statistical Software Package, SPSS software for windows (version 23.0). Descriptive statistics were used to measure the frequency distribution with a P value 0.05. Results: More restrictive arrangements on smoking at home were associated with a greater likelihood of being in an earlier stage of smoking uptake. Based on the questionnaire on the tobacco restriction, 93.9% admitted to having complete restriction on smoking at home, 42.1% had school ban, and 42.1% had strong school ban, whereas 57.9% had no or weak ban 97.7% of the participants followed the restriction on smoking at the public places (P value 0.001). Conclusion: The restrictions at home and public places and enforced bans in schools have a protective effect on teenage smoking.

Keywords: Home, public place ban, school restriction, smoking, smoking ban


How to cite this article:
Kumari M, Saha S, Reddy VK, Sinha P. Prevalence of tobacco use and effect of restrictions on smoking at home, at school, and in public places on teenagers in Lucknow City: A cross-sectional study. J Indian Assoc Public Health Dent 2020;18:246-9

How to cite this URL:
Kumari M, Saha S, Reddy VK, Sinha P. Prevalence of tobacco use and effect of restrictions on smoking at home, at school, and in public places on teenagers in Lucknow City: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2020 [cited 2020 Nov 29];18:246-9. Available from: https://www.jiaphd.org/text.asp?2020/18/3/246/299002




  Introduction Top


Worldwide, tobacco use is the largest cause of morbidity and mortality killing nearly 6 million people each year. According to the World Health Organization (WHO) estimates, globally, there were 100 million premature deaths due to tobacco and its ill effect in the 20th century. The tobacco situation in India is unique because of a vast spectrum of tobacco products available for smoking as well as smokeless use. Smoking of cigarette, particularly bidis and chewing tobacco (smokeless use) is an age-old practice in India. In the developing countries, the tobacco smoking at the age group of 15–69 years rose by about 108 million in 2015 in relative terms from 79 million in 1998.[1]

Tobacco use is a leading cause of cancer, chronic obstructive airway diseases, and cardiovascular mortality; preventable deaths are more in developing countries.

In India alone, nearly 1 in 10 adolescents in the age group of 15–17 years have ever smoked cigarettes, and almost half of these reports initiating tobacco use before 13 years of age. The Global Youth Tobacco Survey (GYTS) India report suggests that 14.1% of school children aged 13–17 years currently use any of the available tobacco products. Factors that commonly play a role in initiation of smoking among adolescents include peer pressure, friends, psychological relaxation, smoking among family members, economic factors, and social factors. Smoking among adolescents has also been reported to be associated with other unhealthy life styles such as alcohol consumption and illicit drug use.[2] Restrictions on smoking at work and home are associated in adults with reduced daily smoking rate and increased cessation.[3]

Smoking restriction at home, at public places, and at school gives an absolute message to teenagers about the unacceptability of smoking. Exposure to environmental tobacco smoke during childhood has been suggested to increase the tolerance for tobacco smoke and sensitize children to taking up active smoking in their teenage years by reducing the noxious deterrence of the first cigarette.[4],[5]

Any intervention that promotes reduced consumption or increased quit attempt duration is likely to increase the eventual chances of successful cessation.

Till date, there are very few studies depicting the prevalence of tobacco habits and effect of restrictions of smoking. Hence, the present, cross-sectional study was conducted to determine the prevalence of tobacco use and effect of restrictions on smoking at home, at school, and in public places on teenagers in Lucknow city.


  Materials and Methods Top


A self-administered, prestructured, and closed-ended questionnaire survey was conducted between March 2017 and August 2017. The study population comprised of 310 secondary school students aged between 14 and 17 years. Approval was obtained from the school administration. Informed consent was obtained from each participant before the study. Convenient sampling was used in the study.

Sample size was calculated using the following standard formula:

n = z 2 (p [1 − p])/e 2 where n = size of the sample;

p = approximate prevalence rate;

z = critical value at a specific level of confidence;

e = difference between sample proportion and population proportion.

The calculation of sample size was performed to seek the results at 95% confidence level for which the value of z = 1.96. The allowable error taken has been 0.05, i.e., = 0.05. The approximate prevalence rate P = 92% according to the previous studies.[1]

The minimum sample required was 310 was found to be sufficient. All the adolescents fulfilling the following inclusion and exclusion criteria participated in the study. The inclusion criteria included: (1) students aged between 14 and 17 years and (2) students who give consent to participate in this study. The exclusion criteria included: (1) Physically challenged students, (2) medically compromised students, and (3) the students who were absent on the day of survey.

The study pro forma had two parts: The first part consisted of structured questionnaire, including demographic details such as name, age, gender, residential address, and name of school from the child. Along with demographic details, information about the personal habits of the students such as use of tobacco, pan/gutka chewing was collected. In the second part, questionnaire including oral health measures, such as tooth brushing frequency, material used and along with the effect of restriction at home smoking, school smoking, and at public place smoking.

Home smoking restrictions were defined by the responses to the question: “how is cigarette smoking handled in your home,” “No one is allowed to smoke in my home” termed as some restrictions, “only special guests are allowed to smoke in my home” or “people are allowed to smoke only in the certain areas in my home,” and no restrictions were defined as “people are allowed to smoke anywhere in my home.” The school smoking restrictions questions were asked about whether there was a ban on smoking at their school and if so, how many students obeyed the rule. These included whether a ban existed (school ban or no school ban) and whether a school ban was strong (most or all students comply) or weak (a ban exists but few or no students comply, or no ban).

Statistical analysis

The data collected were analyzed and tested for significance using the Statistical Software Package, SPSS software for windows (version 23.0). Descriptive statistics were used to measure the frequency distribution. Odds ratio (OR) was used to examine the association between smoking status and smoking restrictions calculated by using two by two frequency table with a formula . OR is used as Chi-square test. The level of significance was 5%.


  Results Top


After statistical analysis of the present data, we found almost equal male (49.5%) and female (50.5%) in my sample population, 57.9% of the total subject are from public school and other rest are, i.e., 42.1% were from the private school [Table 1].
Table 1: Distribution of study subject according to the demoic details

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In our study, we found only 1.6% children do not clean their tooth, but most of subject (98.45%) clean their tooth daily. Among those children, who clean their tooth daily, almost half, i.e., 44.4% clean their tooth twice a day and 93.2% of them are using toothpaste for cleaning of tooth [Table 1].

Only 14.6% students were users of smoking form of tobacco and 29.77% students were using smokeless form of tobacco. Among the study participants, 9.7% were having frequency of smoking once as day, whereas 4.9% were smoking more than once a day and rest 85.4% were nonsmokers. From the study subjects, 7.4% were having smoking habit for <1 year, 3.9% had smoked more than 100 cigarettes, and 3.9% were smoking every day [Table 2].
Table 2: Distribution of study subject according to smoking history

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Based on the questionnaire on the tobacco restriction, 93.9% admitted to having complete restriction on smoking at home, 42.1% were having school ban, and 42.1% were having strong school ban, whereas 57.9% were having no or weak ban 97.7% of the participants followed the restriction on smoking at public places [Table 3].
Table 3: Distribution of study subject according to restriction of smoking at home, school, and public places

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The OR of smoking status in relation to restriction at home was 0.123 (OR <1) (P = 0.001) signifying that those with restrictions at home were having less chances of smoking as compared to those having no smoking restriction at home. Similarly, the OR of school ban (0.475) (P = 0.001), type of school ban (0.475) (P = 0.001), and restriction at public place was found to be <1 signifying their inverse association with the smoking status [Table 4].
Table 4: Distribution of study subject according to odds ratio of association of smoking status with different types of restriction

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Stronger public places restrictions had a significantly protective effect on smoking prevalence, and that home smoking restrictions had a stronger protective effect. The existence of a school ban had no effect, but strong school bans were associated with reduced smoking prevalence. For each of the analyses, we found no significant interactions between parental smoking and home bans, or between bans in different environments, on the smoking outcome variables.


  Discussion Top


Tobacco use is the largest cause of morbidity and mortality killing nearly 6 million people each year. According to the WHO estimates, globally, there were 100 million premature deaths due to tobacco and its ill effect in the 20th century. The tobacco situation in India is unique because of a vast spectrum of tobacco products available for smoking as well as smokeless use.

The prevalence of tobacco use among school children in different states in India has been reported to vary from 1.9% to 75.3%. The prevalence of ever tobacco users is 5.2% in the present study, which is lower than that reported by GYTS Haryana, i.e., 71% and Chandigarh 9.2%. Tobacco use was found mostly in boys and negligible among the girls in the present study compared to GYTS Chandigarh, Haryana, which reports 9.2% boys and 3.8% girls use. The prevalence of tobacco use was higher among the 17 years age group students. Majority of tobacco users respond influence of peer pressure as the major factor to initiate tobacco use, existence of weak school ban, followed by parental use in the present study, which is similar to the finding reported by Wakefield MA et al. 2000.[4]

In the present study, the complete restriction of smoking at home was 93.9% and allowed somewhere in the home was 6.1%. The similar finding reported by Farkas AJ et al. 1999.[6],[7],[8],[9],[10],[11],[12] The restrictions of smoking in school was taken as the strong ban and weak ban. The strong ban in the schools was 42.1% and weak ban was 57.9%. The restrictions followed by the students were 87.7%. The similar finding reported by Wakefield et al. 2000.[4] The restriction at public places for smoking were 97.7%, and these restrictions reduce the smoking in students about 97.7% by following the rules of the no smoking at public places. This shows that the restriction of smoking was much higher at the home. This shows that the reason behind majority of prevalence of smoking could be the weak school restriction regarding the smokers.

Our study of the relation between smoking restrictions in a range of environments and smoking behavior of teenagers suggests that restrictions in the home and public places and enforced bans in schools have a protective effect on teenage smoking. These findings are subject to at least four limitations. First, our data are from a cross-sectional survey, which limits attributions about the direction of causality between variables. There may be other factors that influence teenage smoking apart from restrictions on smoking, and these could lead to an artificial relation between restrictions and youth smoking. For example, in places where stronger restrictions exist on smoking in public places, the environment for tobacco control may be more favorable, and there may be other policy influences that promote lower smoking rates by teenagers. We have not controlled for such factors. Our finding in the present study that home smoking bans reduce smoking uptake and prevalence is consistent.


  Conclusion Top


The prevalence of smoking and smokeless tobacco use were higher in 17 years' age group than other age groups. From the present study, it suggests that restrictions in the home and public places and enforced bans in schools have a protective effect on teenage smoking. It also shows that those with restrictions at home had the less chances of smoking as compared to those having no smoking restriction at home, and also, there is very less restrictions on smoking at school, at home and at public places that could be the one reason behind the increased prevalence of smoking.

Recommendations

The school ban for smoking should be strong so that the habit should be stopped from taking by young. Smoking at public places should be stricter by the government so that the habits ratio can be much lesser than the usual. Parents and relatives should also stop smoking at their homes so that the children would be safe from taking that habit from them.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Biener L, Cullen D, Di ZX, Hammond SK. Household smoking restrictions and adolescents' exposure to environmental tobacco smoke. Prev Med 1997;26:358-63.  Back to cited text no. 1
    
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Kapoor SK, Anand K, Kumar G. Prevalence of tobacco use among school and college going adolescents of Haryana. Indian J Pediatr 1995;62:461-6.  Back to cited text no. 2
    
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Caroline M. Effect of smoke free workplaces on smoking behavior: Systematic review. BMJ 2002;325:1-7.  Back to cited text no. 3
    
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Wakefield MA, Chaloupka FJ, Kaufman NJ, Orleans CT, Barker DC, Ruel EE. Effect of restrictions on smoking at home, at school, and in public places on teenage smoking: Cross sectional study. BMJ 2000;321:333-7.  Back to cited text no. 4
    
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Matthew C. The impact of workplace smoking bans: Results from a national survey. Tobacco Control 1999;8:272-7.  Back to cited text no. 5
    
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Farkas AJ, Gilpin EA, Distefan JM, Pierce JP. The effects of household and workplace smoking restrictions on quitting behaviours. Tob Control 1999;8:261-5.  Back to cited text no. 6
    
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Sinha DN. Report on the results of the Global youth tobacco survey in Uttar Pradesh, India; 2002. Available from: http://www.searo.who.int/LinkFiles/GYTSRepUttarPradesh_2002.pdf. [Last accessed on 2005 Jul 25].  Back to cited text no. 7
    
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Ritesh R, Aditya T. Prevalence of tobacco use among school and college going adolescents of Bhopal. J Evolution Med Dent Sci 2015;4:815-20.  Back to cited text no. 8
    
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Reddy KS, Arora M. Tobacco use among children in India: A burgeoning epidemic. Indian Pediatr 2005;42:757-61.  Back to cited text no. 9
    
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Sinha DN, Reddy KS, Rahman K, Warren CW, Jones NR, Asma S. Linking global youth tobacco survey (GYTS) data to the WHO framework convention on tobacco control: The case for India. Indian J Public Health 2006;50:76-89.  Back to cited text no. 10
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11.
Flay B. Youth tobacco use: Risks, patterns and control. In: Orleans CT, Slade J, editors. Nicotine Addiction: Principles and Management. New York: Oxford University Press; 1993.p. 365­84.  Back to cited text no. 11
    
12.
Sujata M, Ann J A, Prakash C, Brendon P, Faujda R, Dhirendra NS, et al. Trends in bidi and cigarette smoking in India from 1998 to 2015 by age, gender, and education. BMJ Global Health 2016;1:e000005.  Back to cited text no. 12
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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