|Year : 2021 | Volume
| Issue : 4 | Page : 264-268
Second-hand smoke exposure at home and indoor work area among college students in Mangalore, South India
Praveen S Jodalli, Ganesh Shenoy Panchmal, RJ Ancy, Amitha N Basheer
Department of Public Health Dentistry, Yenepoya Dental College, Yenepoya Deemed to be University, Mangalore, Karnataka, India
|Date of Submission||25-Jan-2021|
|Date of Acceptance||16-Oct-2021|
|Date of Web Publication||15-Dec-2021|
Praveen S Jodalli
Department of Public Health Dentistry, Yenepoya Dental College, Yenepoya Deemed to be University, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Second-hand smoke (SHS) causes more than 1.2 million premature deaths per year and other serious diseases. Aim: The aim of the present study was to determine exposure to SHS among college students in Mangalore, South India. Methods: This cross-sectional study was done among 2063 college students aged 18–24 years in Mangalore. Data regarding exposure to SHS at home and indoor work areas were collected. Chi square test was used to test the association between study variables. Multinomial logistic regression was used to find factors influencing SHS exposure. Results: In the present study, 9.9% of the respondents were exposed to tobacco smoke at home of which 8.4% were nonsmokers. Among the respondents, 21.7% were exposed to tobacco smoke at indoor work areas of which 19.3% were nonsmokers. Significant association was found between current tobacco smoking status and anyone smoking inside the home or workplace. Logistic regression analysis revealed that males had 1.814 more odds of getting exposed to SHS at home and 1.976 more odds of getting exposed to SHS at indoor work areas than females. Conclusion: Exposure to SHS was higher at indoor work areas than at home and majority of the respondents exposed to SHS were nonsmokers. The findings emphasize the need for increased efforts to implement strategies to control SHS exposure.
Keywords: Environmental-tobacco smoke, passive smoking, second hand smoke, tobacco, young adults
|How to cite this article:|
Jodalli PS, Panchmal GS, Ancy R J, Basheer AN. Second-hand smoke exposure at home and indoor work area among college students in Mangalore, South India. J Indian Assoc Public Health Dent 2021;19:264-8
|How to cite this URL:|
Jodalli PS, Panchmal GS, Ancy R J, Basheer AN. Second-hand smoke exposure at home and indoor work area among college students in Mangalore, South India. J Indian Assoc Public Health Dent [serial online] 2021 [cited 2022 Jan 22];19:264-8. Available from: https://www.jiaphd.org/text.asp?2021/19/4/264/332540
| Introduction|| |
The tobacco epidemic is one of the world's greatest public health challenges ever, killing more than 8 million people worldwide a year. About 7 million of those deaths are the result of heavy use of cigarettes while about 1.2 million are the result of exposure to second-hand smoke (SHS) by nonsmokers.
SHS is the smoke that fills the confined spaces when people burn tobacco products such as cigarettes, bidis, and water pipes. There is no healthy level of exposure to second-hand cigarette smoke, which causes more than 1.2 million annual premature deaths and severe cardiovascular and respiratory diseases. About half of the children breathe air contaminated by cigarette smoke daily in public areas, and 65,000 die each year from diseases due to SHS. This increases the risk of sudden infant death syndrome in infants. It also causes complications in pregnancy and low birth weight in pregnant women. Smoke-free laws protect the health of nonsmokers and are popular because they do not harm business and encourage smokers to quit. Nonetheless, 93% of the world's population still lives in countries not covered by 100% smoke-free public health regulations, and home exposure to SHS is still common.
SHS is also known as environmental tobacco smoke. This is a combination of two types of smoke from burning tobacco: Mainstream smoke (smoke exhaled by a smoker) and sidestream smoke (smoke from the lighted end of a hookah burning cigarette, pipe, or cigar). Side stream smoke has higher concentration of cancer causing agents (carcinogens) and is more toxic than mainstream smoke. When SHS is exposed to nonsmokers, it is called unconscious smoking or passive smoking. Non smokers breathing in SHS inhale nicotine and toxic substances in equal amounts to those of the smokers. SHS has been known to cause cancer. This has more than 7000 chemicals that can cause cancer.
The workplace is a major source of SHS exposure for many adults. The occupational safety and health administration and the National Institute for Occupational Safety and Health, federal agencies responsible for health and safety in the workplace, recognize there are no known safe levels of SHS and recommend that exposures be reduced to the lowest possible levels.
WHO framework convention in 2004 makes it necessary to provide a “Smoke-free environment” to protect the health of nonsmokers from SHS in indoor workplaces, public transport, indoor public areas, and other public areas.
WHO MPOWER approach; the global strategy for tobacco control was drawn up in 2008. The following control actions must be taken by all the signatory governments: Monitor tobacco use and precaution policies, Protect people from tobacco smoke, Offer help to quit tobacco use, Warn people about the dangers of tobacco use, Enforce bans on tobacco advertising, promotion, and sponsorship, and Raise taxes on tobacco.
This research provides a comprehensive overview of the tobacco problem related to SHS among college students in Mangalore, Dakshina Kannada. This study will help to synthesize the available scientific knowledge on SHS and the health problems caused, identifying the gaps in knowledge, reviewing policies and attempts toward reducing the tobacco burden, and providing a credible basis for evolving future tobacco control policies.
| Methods|| |
A cross-sectional study was carried out among 2,063 college students aged 18–24 years in the colleges of Mangalore (Government colleges, private institutions, and universities) from January 2016 to June 2018. Before initiating the study, official permission was obtained from the authorities concerned, and from the selected colleges. Ethical approval from the Institutional Ethics Committee was obtained (YUEC 200/12/10/2015).
The sample size of 2063 was calculated from Open Epi, info version 3, open-source calculator-SS proper (OpenEpi Development Team, USA).
A geographically clustered multistage random sampling was used, to identify the study areas. The sampling procedure was carried out in 3 stages. In stage one, information regarding the total number of colleges (n = 148) in Mangalore was obtained. Using proportionality sampling (20% proportion), 30 colleges were selected randomly. In stage two, information regarding the total strength of each sampling unit was collected and 69 subjects were selected per college. Moreover in stage three, both male and female college students, aged 18–24 years, were selected using a simple random sampling technique.
The purpose of the study was explained and informed consent from the study participants was taken before starting the study.
The study included all eligible college students, aged 18–24 years, who are native to Mangalore, who were present in the college/institution at the time of data collection and those who gave consent to participate in the study.
Individuals with systemic diseases, history of drug abuse, and psychiatric illness were excluded from the study.
Individuals who participated in the study were provided with a participant information brochure. The proforma used for the present study is a validated, recommended subset of key (Global Adult Tobacco Survey) questions. The proforma prepared also consisted of demographic data including the name of student and college, date of birth, age, gender, course opted, educational qualification, and occupation of parents. A face-to-face interview method was used for data collection. The pro forma used in the present study estimates exposure to SHS among the study participants. This is an indirect measure of the impact of tobacco control and precaution initiatives. During this visit, the study participants were elaborated on different aspects of tobacco use and its ill effects. Participants, who expressed a desire to quit the habit of tobacco use, were referred for habit counseling.
The data were subjected to statistical analysis using Statistical Package for the Social Science (SPSS) version 24.0 (IBM, Chicago Inc., IL, USA). Descriptive statistics such as categorical data are presented in the form of the frequency with percentages in brackets and 95% confidence interval. Fischer exact test/Chi-square test was used to test the association between study variables. Multinomial logistic regression was used to find the factors influencing SHS exposure. The level of significance was set at P < 0.05.
| Results|| |
The present study was carried out to determine the prevalence and factors influencing exposure to SHS among 2063 college students aged 18–24 years in Mangalore, South India. The study consisted of both males and females. In the present study, 64.2% of the participants were females and more than half of the participants (60.2%) were residing in the urban areas. Among the study participants, 71.9% were enrolled for undergraduate degree courses, 5.7% were enrolled for technical degrees and 22.4% were enrolled for health professional degrees.
[Table 1] shows that an overall 9.9% of the respondents were exposed to tobacco smoke at home, among them 8.4% were nonsmokers. Compared to females, males (13.4%) were more exposed to SHS at home. Participants from urban areas (10%) were more exposed to tobacco smoke at home than participants from rural areas. Undergraduate degree students (10.4%) were more exposed to tobacco smoke at home, than technical degree students and health professional students.
|Table 1: Exposure to tobacco smoke at home, by smoking status and selected demographic characteristics (n=2063)|
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In the present study, overall 21.7%of the respondents were exposed to tobacco smoke at indoor work areas, among them 19.3% were nonsmokers. Compared to females, males (25.3%) were more exposed to SHS at home. Participants from urban areas (26.0%) were more exposed to tobacco smoke at home than participants from rural areas. Moreover, technical degree students (31.2%) were more exposed to tobacco smoke at home, than undergraduate degree students and health professional students [Table 2].
|Table 2: Exposure to tobacco smoke at indoor work areas, by smoking status and selected demographic characteristics (n=2063)|
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[Table 3] shows that there was a significant association (P < 0.001) between current tobacco smoking status and the frequency of anyone smoking inside the home (N = 2063). Majority of the participants did not smoke at all.
|Table 3: Association between current smoking habit and frequency of anyone smoking inside the home (n=2063)|
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[Table 4] shows that there was a significant association (P < 0.001) between current tobacco smoking status and anyone smoking at the workplace (N = 2063). Majority of the participants did not smoke at all.
|Table 4: Association between current smoking habits and anyone smoking at workplace (n=2063)|
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Among individuals exposed to SHS at home, males had 1.814 more odds of getting exposed to SHS than females, which was statistically significant. And among individuals exposed to SHS at indoor work areas, males had 1.976 more odds of getting exposed to SHS than females, which was statistically significant [Table 5].
|Table 5: Logistic regression analysis to determine factors influencing exposure to second-hand smoke (n=2063)|
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| Discussion|| |
The present study is one of the largest studies conducted, among college-going students in Southern India, to determine the exposure to SHS.
Exposure to SHS is fatal; there is no safe level of tobacco smoke exposure. The WHOFCTC states: “Article 8: Each party shall adopt and implement measures, providing for protection from exposure to tobacco smoke in indoor workplaces, public transport, and other public places.” The smoke-free laws are practical, popular and they protect the people. The Government of India ratified article 8 in 2004, making it necessary to provide a “smoke-free environment to protect the health of nonsmokers.” This article was enforced from October 2, 2008, onwards, with a complete ban of smoking in all public places, including educational and health institutions, entertainment and hospitality places, public transport, and work-places.
In the present study, smoking frequency by any individual at home was less (9.9%) and among them, majority were nonsmokers (8.4%). This was independent of either gender, or the place where they belong to, or the course the participants were studying. The European region has the highest frequency of smoking at home (78.0%), while the lowest is recorded in the African region (mean 30.4%). In other regions, exposure at home ranged from 50.5% in the Western pacific region to 37.0% in the Southeast Asian region. Data from Global Youth Tobacco Survey, conducted in 29 African countries, among students (N = 56,967), aged 13–15 years, revealed that home exposure to SHS ranged from 12.7% (Cape Verde) to 44.0% (Senegal) among never-smoking students. The difference in the findings between the different studies might be due to the awareness among parents regarding the ill effects of tobacco smoking and their fear that the children might initiate the habit of smoking.
In the present study, males (13.4%) were more exposed to SHS at home than females. Contrary to this, a study was carried out by Jallow et al., in The Gambia, to obtain the prevalance of SHS exposure, found out that it was more common for girls to be exposed to SHS at home.
In the present study, participants from urban areas were more exposed to tobacco smoke at home as well as indoor work areas than participants from rural areas. However, a study conducted by Singh and Sahoo, found that the SHS exposure is more in rural areas than in urban areas, at their workplace and at home.
Exposure to SHS is a significant health risk for smokers and nonsmokers. Thus reduction of this exposure should be a primary component of any National Comprehensive Tobacco Control Programs. Educating women about the negative consequences of the SHS, and encouraging them to make their household smoke-free could be a good initiative in this direction. This empowerment education plays an important role in protecting women, their children, and other members at home.,,,
The tobacco control program tends to fail if the laws are not strictly imposed. The use of tobacco by peers/friends at workplace, may contribute to the renormalization of behavior related to the use of tobacco products; The students of this age group (18–24 years) are particularly vulnerable to visual cues and social norms. The smoke-free laws may successfully lower the risk of SHS exposure. This indirectly reduces the number of new tobacco users and also supports people who want to quit smoking. Although India has successfully implemented several laws, the use of tobacco in homes and public places is still high; home is not included in smoke-free policy. Even though the urban areas are strict in these policies, the rural areas have been neglected in most of the countries of the South East Asian region.
The study is not free of limitations. In the study setting, social norms (i.e., unacceptability of females using tobacco) might result in under-reporting and inability to make temporal associations due to the cross-sectional nature of the study.
| Conclusion|| |
This study has shown that exposure to SHS was high at indoor work areas than at home and majority of the respondents exposed to SHS were nonsmokers. Despite smoke-free laws, protection against SHS exposure is still inadequate. There is an immediate need for measures to reduce the existing level of SHS exposure. This highlights the need to establish robust smoke-free regulations in all areas and to strictly enforce those laws. The results of the study will help the Government to take action and implement comprehensive tobacco control and prevention strategies, which could be impactful in fighting the tobacco epidemic.
The authors would like to thank all respondents who participated in the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
GTSS Collaborative Group. A cross country comparison of exposure to second hand smoke among youth. Tob Control 2006; 15 Suppl 2: 14-19.
Lee KA, Palipudi KM, English LM, Ramanandraibe N, Asma S; GYTS Collaborative Group. Secondhand smoke exposure and susceptibility to initiating cigarette smoking among never-smoking students in selected African countries: Findings from the Global Youth Tobacco Survey. Prev Med 2016;91S: S2-8.
Jallow IK, Britton J, Langley T. Prevalence and factors associated with exposure to secondhand smoke (SHS) among young people: A cross-sectional study from the Gambia. BMJ Open 2018;8:e019524.
Singh A, Sahoo N. Urban-rural differentials in the factors associated with exposure to second-hand smoke in India. BMJ Open 2013;3:e003542.
Whincup PH, Gilg JA, Emberson JR, Jarvis MJ, Feyerabend C, Bryant A, et al.
Passive smoking and risk of coronary heart disease and stroke: Prospective study with cotinine measurement. BMJ 2004;329:200-5.
California Environmental Protection Agency. Proposed Identification of Environmental Tobacco Smoke as a Toxic air Contaminant; 2005. Available from: https://escholarship.org/uc/item/8hk6960q
. [Last accessed on 2021 Jun 24].
Singh RJ, Lal PG. Second-hand smoke: A neglected public health challenge. Indian J Public Health 2011;55:192-8.
] [Full text]
Lin PL, Huang HL, Lu KY, Chen T, Lin WT, Lee CH, et al.
Second-hand smoke exposure and the factors associated with avoidance behavior among the mothers of pre-school children: A school-based cross-sectional study. BMC Public Health 2010;10:606.
U.S. Department of Health and Human Services. Preventing tobacco use among youth and young adults: A Report of the Surgeon General. 2012. Available from: https://www.ncbi.nlm.nih.gov/books/NBK99237/
. [Last accessed on 2021 Jun 20].
Palipudi KM, Sinha DN, Choudhury S, Mustafa Z, Andes L, Asma S. Exposure to tobacco smoke among adults in Bangladesh. Indian J Public Health 2011;55:210-9.
] [Full text]
Pisinger C, Hammer-Helmich L, Andreasen AH, Jørgensen T, Glümer C. Social disparities in children's exposure to second hand smoke at home: A repeated cross-sectional survey. Environ Health 2012;11:65.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]