|Year : 2020 | Volume
| Issue : 2 | Page : 76-80
A cross-sectional study on tobacco use prevalence and reasons for its use among male youth in a resettlement colony of Delhi
Vikas Yadav1, Deepti Dabar2
1 Department of Community Medicine, Atal Bihari Vajpayee Government Medical College, Vidisha, Madhya Pradesh, India
2 Department of Community and Family Medicine, AIIMS, Bhopal, Madhya Pradesh, India
|Date of Submission||15-Jul-2019|
|Date of Decision||07-Sep-2019|
|Date of Acceptance||19-Nov-2019|
|Date of Web Publication||10-Sep-2020|
Dr. Vikas Yadav
MD Community Medicine, Assistant Professor, Department of Community Medicine, Atal Bihari Vajpayee Government Medical College, Vidisha, Madhya Pradesh, 464001
Source of Support: None, Conflict of Interest: None
Introduction: It is estimated that 5,500 adolescents started using tobacco every day in India. The prevention of tobacco use in young Indians appears to be one of the largest opportunities for controlling this ever-growing epidemic. In India, like in other developing countries, the most susceptible time for initiation of tobacco is during youth, that is in the age group of 15–24 years. Material and Methods: This cross-sectional study was conducted in Kalyanpuri, a resettlement colony in New Delhi, India. The study included males aged 15–24 years residing in the study area at the time of survey. A semi-structured interview schedule was designed and translated into Hindi to elicit information on tobacco use. Results: Prevalence of tobacco use (ever user) was found to be 31.3%. Among ever users, 225 (27.7%) were current users and 9 (3.6%) were past users. Peer pressure (140, 62.2%) was found to be most common reason for initiation, whereas habit (143, 63.5%) of having tobacco was most common reason for continuation of tobacco use.
Keywords: Continuation, initiation, prevalence, reason, tobacco, youth, India
|How to cite this article:|
Yadav V, Dabar D. A cross-sectional study on tobacco use prevalence and reasons for its use among male youth in a resettlement colony of Delhi. J Assoc Chest Physicians 2020;8:76-80
|How to cite this URL:|
Yadav V, Dabar D. A cross-sectional study on tobacco use prevalence and reasons for its use among male youth in a resettlement colony of Delhi. J Assoc Chest Physicians [serial online] 2020 [cited 2020 Sep 24];8:76-80. Available from: http://www.jacpjournal.org/text.asp?2020/8/2/76/294586
| Introduction|| |
Currently about one-fifth of all worldwide deaths attributed to tobacco occur in India, more than 8,00,000 people die and 12 million people become ill as a result of tobacco use each year. The deaths attributable to tobacco in India are expected to rise from 1.4% of all deaths in 1990 to 13.3% by 2020. It is estimated that 5,500 adolescents start using tobacco every day in India. Thus the prevention of tobacco use in young Indians appears to be one of the largest opportunities for controlling this ever-growing epidemic. The prevention policies, if successfully executed, would not only prevent the various non-communicable diseases attributed to tobacco use, but also decrease its social and economic burden on the society.
Studies suggest an increase in the prevalence of regular tobacco use among urban youth in India. To deal with this problem, a closer look is needed, to know more about magnitude and pattern of tobacco use. Study conducted in the two metropolitan cities (Delhi and Chennai) found that current tobacco use among teenagers was estimated to be 14.7%, of which 7.4% had smoked cigarettes and 10.8% had chewed tobacco. The Global Youth Tobacco Survey (GYTS) 2003, a study among 13–15 year olds, estimated that ever user for tobacco were 10% in Delhi. National Family Health Survey-3 (NFHS-3) conducted in 2005–06 has reported 27% prevalence of tobacco use among 15–24 years age group males in Delhi.
Increased tobacco use by the population can often first be recognized by increased use among young people, since most people begin using tobacco while they are teenagers, become addicted, and thereby become adult users, carrying the wave of increased use into the population over time. In India, like in other developing countries, the most susceptible time for initiation of tobacco is during youth, that is in the age group of 15–24 years. Some start tobacco use at young age of 10 years but the majority of users start using tobacco in 15–24 years age. Tobacco habit is far more prevalent in males as compared to females. This signifies the importance of identifying this age group as prime target for promotion and preventive interventions.
While there are many aspects to the problem, tobacco use initiation and continuation among the youth of the nation is clearly one of the most defined horizons. Though hospital-based studies on tobacco morbidity and various forms of tobacco consumption have been done earlier, community-based studies are few. It is essential to elicit burden and route causes, due to which male youth (15–24 years) initiate and continue the tobacco consumption in their life. So this study was planned to determine prevalence and to throw light on reasons for initiation and continuation of tobacco consumption among the male youth in urban resettlement colony of Delhi.
| Materials and Methods|| |
This cross-sectional study was conducted in Kalyanpuri, a resettlement colony in New Delhi, India. The study included males aged 15–24 years residing in the study area at the time of survey. Ethical approval was obtained from institutional ethical board. Participants information sheet was provided to all the participants and written informed consent was obtained from them.
From previous study, the prevalence of tobacco consumption among 15–24 years male was 14.7%, which would require a sample size of at least 762 subjects to estimate the prevalence of tobacco consumption with 2.5% absolute precision and with 95% confidence. Therefore, we decided to collect data from at least 800 participants.
The area has 11 blocks (No. 11–21) with a total population of nearly 34,000. The total population of 15–24 years aged males were nearly 4,000 (as per population: male ratio in Delhi Census 2001). There are 4,700 houses (180–500 houses in each block). Every fifth house (total 940 houses) was selected by the systematic random sampling method in each of the 11 blocks of the area to cover sample size of 800 subjects. From each of the selected houses, all males of 15–24 years of age were selected. Following a brief introduction, the purpose of the study was explained to the male youth, confidentiality was ensured, and written consent was sought. If the study subject was not at home or could not spare time, more visits were planned. Who did not consent or not available at three visits were excluded from the study. Because of the personal nature of some enquiries, special efforts were made to establish rapport with the respondents and confidentiality of the information was assured. An attempt was made to conduct the interview in privacy to have an opportunity for responses on all issues.
A semi-structured interview schedule was designed and translated into Hindi. It was pretested to elicit information on tobacco use. Data collection was done in the years 2010–2011. Subjects were classified into tobacco ever users /never (or non) users/current users as per the definitions used in Global Youth Tobacco Survey (GYTS). “Ever users” were defined as anyone who had used tobacco even once in any form at any point in a lifetime. “Never users” were those who had never used tobacco. “Current users” were those who had used tobacco in any form during the 30 days preceding the survey and “past users” were defined as ever users who were not current users.
All statistical analysis is descriptive. Prevalence and type of tobacco use have been described in absolute numbers and percentages (prevalence). Data of reasons (initiation and continuation) are also presented as number and percentages in table. All the analysis has been done in SPSS 18 software (SPSS Inc. Released 2009. PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc.).
| Results|| |
Total 940 (20%) houses among 4,700 were surveyed and 860 subjects were listed. The proportion of study subjects (15–24 years male) in population in studied houses was found to be 12.34%. Out of these 860 participants, only 811 (94.3%) subjects who consented were interviewed. Prevalence of tobacco use (ever user) was found to be 31.3% (254 out of 811 participants), who had consumed tobacco even once in any form. Among these 254 tobacco users, 225 (27.7%) were current users, who had consumed tobacco in any form during last 30 days and 9 (3.6%) were past users, who consumed tobacco in past but had not consumed it in last 30 days.
Most common practice was to take tobacco in smokeless form 89(39.6%). Current user practices taking tobacco in both form (smoking and smokeless) (74, 32.9%) more than smoking only (62, 27.6%) [Table 1]. Mean age of initiation of tobacco use was 14.91 ± 2.2 years (median = 15 years).
Peer pressure (140, 62.2%) was found to be most common reason for initiation followed by getting pleasure (129, 57.3%) out of it. Most common reason for continuation was found to be having habit (143, 63.5%) to consuming tobacco followed by getting pleasure (96, 42.7%) on consuming it. Complete list of reasons for initiation and continuation is given in [Table 2].
|Table 2 Reasons for initiation and continuation of tobacco products among current users|
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| Discussion|| |
The study was conducted at Kalyanpuri resettlement colony among 15–24 years males. Total 940 houses were surveyed and 860 subjects were listed. The proportion of 15–24 years males in the study population in sampled houses was 12.34%, which is similar to Delhi census 2001 (11.77%). Finally, 811 male youths who were available and consented for participation in the study were interviewed.
Magnitude of tobacco use
In present study nearly one third (31.3%) study subjects had used tobacco sometime or other (ever users). Whereas 68.7% of the subjects had never used tobacco. Most of the youth who had ever used tobacco continued to use tobacco and had consumed tobacco in last one month (current users-27.7%), only 3.6% were past users.
Similar results were observed by other studies also. NHFS 3 also reported prevalence of tobacco use as 27%, for the same age group in Delhi. Kumari et al. in male medical students in Lucknow found current users were 28.8%.
Very high consumption of tobacco was reported by some studies as in Dongre et al., who carried out a study in 385 adolescents of 15–19 years age group in rural Wardha and found ever users of tobacco to be as high as 68.3% in boys. High prevalence was also reported by Bala et al. in males above 18 years in Gujarat; he found 61.89% ever users and 47.6% current users.
Lower prevalence was also reported in some studies. Bhojani et al. in 14–19 years in Bangalore reported ever users and current users 15.7% and 5.3%. Low prevalence was also found in Kapil et al., who reported current users were 2.1% among adolescents in Delhi. Such low prevalence was also reported by Singh et al. in Delhi in 11–18 years subjects, in which they found ever users were 9.8% and current users were 5.4%. Tsering in 7–10 class students in West Bengal found ever users were 11.3 % in urban area. The lower prevalence in these studies could be due to the lower age of subjects included in these studies.
Pattern of tobacco use
In the current study one third current users indulged both in smokeless tobacco and smoking. Smokeless tobacco use was more common (particularly in 15–19 years age groups). Of 225 current users 163, that is 72.5%, used smokeless tobacco, whereas 136, that is 60.5%, smoked and 74, that is 32.9%, used both forms.
Sinha et al., who conducted a cross-sectional survey in subjects above 15 years in Akhta village, Bihar, also reported higher use of smokeless tobacco. They found that among males, 74.1% were tobacco users, 42.6% were smokeless tobacco users, and 31.6% were smokers.
Kumari et al. found that out of 72 current users, among 250 male medical students at KGMC Lucknow; 63(87.5%) were smokers and 27(37.5%) were smokeless tobacco users. This is different from the findings in the present study. Kalyanpuri, being a resettlement colony with the subjects mostly belonging to the lower socio-economic and educational status, it is easier and cheaper to buy smokeless forms of tobacco. Cigarettes, being more expensive, are not consumed as much as smokeless forms.
Similar findings were reported by Singh et al. (10–18 years, New Delhi, 2007) and Malhotra et al. (10–18 years boys, New Delhi, 2003) who reported that most common product consumed by current tobacco users was gutkha. Jindal et al. (Chandigarh, Delhi, Kanpur, Bangalore 2006) and Saha et al. (Hooghly, West Bengal 2008) also reported in their studies among above 35 years and 15–35 year olds respectively that bidi smoking was more common than cigarette smoking.
Age at initiation of tobacco use
In current study, mean and median age at initiation of tobacco was found to be 14.91±2.2 years and 15 years, respectively.
Other studies have also reported early initiation of tobacco use during adolescence. Sreeramareddy et al. (Nepal, 2008), in their study in 14 to 32 year olds, found that majority (89.6%) of ever smokers initiated smoking between the age of 12 and 18 years with a median of 16 years. Among chewable tobacco users also, 73.7% had initiated between ages of 12 and 18 years, median age of 15 years. Bala et al. from Gujarat also reported that the age of initiation among 18–25 years age group was varied but was more commonly 11–15 years (34.7%) followed by 16–20 years (30.17%), 21–25 years (14.3%), and least in 5–10 years (9.1%). Initiation of tobacco use before 20 years of age was also reported in 89% users by Qadri et al. from Pakistan.
Malhotra et al. in a study in street children (6–18 years) in Delhi reported early initiation of tobacco use with 60.9% of the children smoked and 64.5% consumed smokeless tobacco before 10 years of age The possible reason could be that the street children, not having any family or social support system, being illiterate, and unemployed, are an easy prey to substance abuse.
Reasons for initiation and continuation
The most common reasons for starting tobacco use in the present study were peer pressure (62%), fun/pleasure (57%), and experimentation/curiosity (52%). Most common reason for continuing tobacco use was however habit, reported by 63% of current users. Other reasons were fun/pleasure (43%) and peer pressure (27%). The findings were similar to study conducted by Bhojani et al. in Bangalore in pre-university students. In their study it was found that influence from friends (in various forms from insistence to persuasion to forced initiation) was the most common reason for initiation of tobacco use (25.5%) by ever users. Other reasons included consuming “for the sake of fun” (14.8%), “curiosity to try tobacco products” (12.8%), and “for style” (10.6%).
Dongre et al. in rural Wardha also found that pear pressure (51.2%) was the most common reason for initiation. The findings were similar to finding of present study.
Singh et al. in Delhi, Qadri et al. in Karachi, Pakistan, Kapil et al. in Delhi, Malhotra et al. in Delhi, Athavale in Nagpur, Kumari et al. in Lucknow, and Kotwal et al. in Delhi, all in their respective studies found peer pressure to be the most common cause of initiation of tobacco use, further corroborating the results obtained in the present study.
For continuation of tobacco use, similar findings have been reported by Bhojani et al., who reported that “addiction” (31.3%) was the most common reason for the continuation among current users.
Malhotra et al. in Delhi, in 10–18 years boys, found the most common reason for continuation of tobacco use to be addiction, the same as the present study. However, Dongre et al. in Wardha (in 15–19 years) and Kotwal et al. in New Delhi (in 15–17 years) found peer pressure and not addiction to be the most common reason for continuation. The explanation for results may be younger age group were selected in both the studies and having addiction unlikely. Addiction requires time to develop, and is therefore, the most common cause of continuation of tobacco use in older age groups.
| Conclusion|| |
Prevalence of tobacco use (ever user) was found to be 31.3% (254 out of 811 participants). Among these 254 tobacco users, 225 (27.7%) were current users and 9 (3.6%) were past users. Peer pressure (140, 62.2%) and habit of tobacco consumption (143, 63.5%) were found to be most common reasons for initiation and continuation respectively, for tobacco use among current users.
Results of current study clearly shows that youth requires continued motivation at the level of school, family, and community, to resist peer pressure. Parents, school teachers and informal community leaders need to be involved to prevent youth from starting tobacco use. Parents and teachers should be able to look out for signs of addiction in these youth. Since once they start, they soon get into habit, which is difficult to quit. Inclusion of these topics should be made in the school curriculum. Cessation should be promoted through educational efforts to motivate tobacco users to quit and create community-based cessation facilities to assist them in doing so. These support programs should present accurate information and discuss the risks associated with tobacco use in younger age groups.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]