|Year : 2010 | Volume
| Issue : 5 | Page : 59-62
Why youth smoke? An exploratory community-based study from Chandigarh Union Territory of Northern India
JS Thakur, SR Lenka, S Bhardwaj, R Kumar
PGIMER School of Public Health, Chandigarh, India
|Date of Web Publication||9-Jul-2010|
J S Thakur
PGIMER School of Public Health, Chandigarh
Source of Support: None, Conflict of Interest: None
Background: Tobacco use is a serious public health challenge in several regions of the world, including India. Increasingly, steps are being taken at policy level to curb the problem. Aim: This study was done to find out the determinants of tobacco use so that effective intervention programs can be designed and implemented for the prevention and cessation of this growing pandemic. Methods: A community-based cross-sectional study was done adapting Global Youth Tobacco Survey questionnaire prepared by the Centre for Disease Control, Atlanta, among youth (15-24 years). Patterns of smoking and their determinants were calculated using univariate and multivariate analyses. Results: Prevalence of current smoking among youth was 20.4% (95% confidence interval: 16.9-23.9%). Male sex, smoking peers, cigarette advertisements, and feeling comfortable in social gatherings were significant determinants for smoking after adjusting for all explanatory variables. Conclusion: Strict enforcement of regulations pertaining to cigarette advertisements in any form, enabling environment and community interventions focusing on parents and peers are required for effective control of tobacco problem among youth in India.
Keywords: Cigarette, smoking, tobacco, youth
|How to cite this article:|
Thakur J S, Lenka S R, Bhardwaj S, Kumar R. Why youth smoke? An exploratory community-based study from Chandigarh Union Territory of Northern India. Indian J Cancer 2010;47, Suppl S1:59-62
|How to cite this URL:|
Thakur J S, Lenka S R, Bhardwaj S, Kumar R. Why youth smoke? An exploratory community-based study from Chandigarh Union Territory of Northern India. Indian J Cancer [serial online] 2010 [cited 2020 Jan 20];47, Suppl S1:59-62. Available from: http://www.indianjcancer.com/text.asp?2010/47/5/59/63871
Publication of the supplement was supported by the funds from the 14th World Conference on Tobacco or Health, March 8-12, 2009, Mumbai. The Guest Editors, Editors, Authors and others involved with the journal did not get any financial or non-financial benefit from the sponsors.
| » Introduction|| |
Tobacco use is one of the preventable causes of morbidity and mortality in the world. It is the most important identified cause of cancer and is responsible for about 50% of cancers in men and about 20% of cancers in women.  At present, about 4 million people die of tobacco-related diseases every year.  World Health Organization predicts that unless there is a dramatic change in the present trends of tobacco use, it will be killing 8.4 million people a year by late 2020 and hence will become the single largest health problem in the world.  India is the second most populous country in the world and the third largest producer and consumer of tobacco. In India, an estimated 65% of all men and 33% of all women use some form of tobacco.  According to National Family Health Survey-3, 57% of men and 11% of women use tobacco in some form. 
Quitting smoking is very difficult. In population-based studies, more than 60% of people who smoke report intending to quit within the next 6 months, yet only 3-5% achieve a sustained abstinence from tobacco for more than 1 year.  It is estimated that people who smoke need an average of 4 attempts to quit before they are able to maintain a sustained cessation. Smokers average a 16-fold increased risk of acquiring lung cancer, a 12-fold increased risk of chronic obstructive pulmonary disease, and a 2-fold increased risk of having a myocardial infarction in comparison with a nonsmoker.  Stopping smoking substantially reduces mortality risks even among long-term smokers. A person who has quit smoking has 50% less chance of dying due to lung cancer and within 10 years of quitting smoking, risk of death due to lung cancer decreases compared with that of nonsmokers.  There are few epidemiologic studies on the quantitative assessment of smoking and the use of tobacco products in India, but even after exhaustive search, no community-based study could be found about the smoking habits and tobacco use in youth. It is difficult to plan and monitor effective tobacco control strategies and interventions in the absence of adequate data on smoking habits and use of other tobacco products. This study was planned to assess tobacco use and its determinants among youth in Chandigarh, Union Territory of India, which could become a basis for planning intervention to control tobacco menace and in preventing a future catastrophe.
| » Materials and Methods|| |
The study was conducted in Chandigarh, Union Territory of India. Based on the existing data, prevalence of tobacco use among youth was taken to be 20%. Considering alpha error as 5% and design effect of 2, a sample size of 500 was considered to be sufficient for studying the prevalence of smoking and other tobacco products among youth in Chandigarh. It was a cross-sectional study among youth (15-24 years).
Two developed sectors in the city, namely sector 19 and sector 38 were chosen purposely to represent the Northern and Southern parts of the city. Similarly, one periurban slum area, namely Indira Colony and one village named Dhanas were also chosen purposely to represent slum and rural areas, respectively.
To give proportionate representation to each area of Chandigarh, UT, 250 youths were sampled from urban and 125 each from slum and rural areas. In each study site, one house was selected randomly in the middle of the locality and then consecutively next nearest house was included till 125 youths were selected. Thus, a total of 500 youths were sampled for the study. Similar approach was used in the slum and the rural areas.
Global Youth Tobacco Survey questionnaire  prepared by the Centre for Disease Control, Atlanta, was used after translation into Hindi language with slight modification and pretesting for data collection. Data were collected from July 2002 to August 2003. After giving a brief introduction of the study, consent of the participant was obtained. Privacy and confidentiality was ensured to elicit correct information. Questionnaire was administered to both smokers and nonsmokers in the age group of 15-24 years. It took 25-30 min to fill 1 questionnaire.
Analysis was done using Epi info version 2000 (November 2001 release; CDC, Atlanta, GA, USA). For categorical variables, Chi-square test was used. Response variables were ever smoking, current smoking, and use of other tobacco products. Ever smoker was defined as one who had smoked even a single puff and current smoker was defined as one who had smoked in the past 30 days. Various explanatory variables used in the study were age, sex, parental and friend's smoking status, effect of media, education in schools/colleges, and reasons for initiations and maintenance of smoking. Multivariate analysis was done using logistic regression analysis.
| » Results|| |
Out of the 500 youth, 250 were sampled from the urban area, 125 each from the slum and rural areas. Among the total respondents, 61% were males and 39% were females. The median age of the respondents was 18 years in all the 3 areas.
Prevalence of smoking
Prevalence of ever smoking among youth was 26.0% (95% confidence interval [95% CI]: 22.3-30.1%). It was 37.2% (95% CI: 31.7-42.9%) in males and 8.7% (95% CI: 5.1-13.5%) in females. Prevalence of smoking was significantly higher among males than in females in all the study areas (P < 0.001). Out of 500 youth, 20.4% (95% CI: 16.9-23.9%) were current smokers. Prevalence of current smoking among males was 29.9% (95% CI: 24.8-35.0%) as compared with 5.6% (95% CI: 2.4-8.8%) in females. Prevalence of smoking was significantly higher (P < 0.001) in the age group of 20-24 years (39%) as compared with that in the age group of 15-19 years (22%). It was found that two-fifth of youth started smoking before the age of 14 years. In slums, 67.9% of smokers smoked daily as compared with 41.2% in the rural and 31.6% in the urban areas. Most of the smokers (56.9%) smoked 2-5 cigarettes per day.
Perceptions and Attitudes of Youth About Smoking
Out of the total 500 respondents, 55% said that it was difficult to quit if somebody started smoking cigarettes, whereas 3% said it was not at all difficult to quit. Nearly 10% of the urban youth thought that boys who smoke have more friends, while 13.6% of youth from slum area and 12% of youth from rural area thought so. In the urban area, 24.4% of youth thought that smoking makes looks attractive, whereas 34.4% in the slum area and 25.6% in the rural area thought so; 68.5% smokers were of the view that smoking makes one feel comfortable in a social gathering, while 8.9% nonsmokers thought the same, which was found to be highly significant (P < 0.001).
Determinants of smoking
Forty-eight percent of parents of smokers also smoked as compared with 37.8% parents of nonsmokers and this was found to be statistically significant (P = 0.04). About 97% of the young smokers had one or more smoker friends as compared with 49% of nonsmokers, which was found to be statistically significant (P < 0.001). Smokers had seen cigarette advertisement in the media more often (85.4%) than the nonsmokers (61%) and this finding was found to be statistically highly significant (P < 0.001). About half of the nonsmokers (55.5%) were told about the dangers of smoking in the school/college, whereas only one-third smokers (33.3%) were told about it and the difference was found to be highly significant (P < 0.001).
The main reason for initiating smoking according to smokers was friend's influence (81.5%) followed by curiosity (64.5%), and tension (33%). Similar reasons were told by nonsmokers also. The common reason for smoking was tension according to smokers (73.1%) and nonsmokers (65.9%). The most common reason for the development of an urge for smoking among youth was tension (68.0%), which was highest in the urban area (73.6%), followed by the slum area (69.6%), and the rural area (55.2%). The second most common reason for this was social gathering (34.4%) followed by work environment (29.8%).
Logistic regression was done by considering the presence or absence of smoking as the response variable and type of residence area, sex of the respondents, parental status of the smoker, friend's status of smoking, and exposure of respondents to prosmoking messages in media as the explanatory variables. After adjusting for all the variables, the odds ratio of male sex, having friends who smoke, exposure to prosmoking messages in the media, and the perception that smoking makes one feel comfortable in social gatherings have attained the level of significance [Table 1].
| » Discussion|| |
Most of the studies from India were school/college based, which excludes the youth not attending school/colleges. Keeping this in view, a community-based study was planned to find out the prevalence, pattern, and determinants of tobacco use among youth.
The prevalence of ever smoking in this study was 26.0% (27.2% in males and 8.7% in females). In almost all the studies, the prevalence of smoking in males is much higher as compared with prevalence of smoking among the females. The finding is similar to the present study. In the present study, prevalence of smoking is significantly higher among the males (37.2%) as compared with females (8.7%) (P < 0.001).
It was found that 47.7% smokers' parents were also smokers, whereas 37.8% nonsmokers' parents were smokers and the difference was found to be statistically significant (P < 0.05). It is imperative that while designing intervention for tobacco control, this factor should be borne in mind and parents should be advised to refrain from smoking in front of their children.
In the present study, it was noted that 97% of the young smokers had one or more smoker friends as compared with 49% of nonsmokers, this association was found to be statistically significant (P < 0.001). In all the 3 study areas, >90% of the young smokers had one or more smoker friends. Having friends who smoked substantially increased the likelihood of being a smoker. It was noted in the present study that 36.5% respondents (N = 200) were using other tobacco products. The prevalent use of other tobacco products was higher in rural (58.8%) as compared with that in slum (32.6%) and urban areas (27.2%). Therefore, in any tobacco control strategy, nonsmoking tobacco products should also be adequately covered.
It was found that 68.5% smokers had the opinion that smoking made them feel comfortable in social gatherings, whereas only 8.9% nonsmokers felt the same and this was found to be highly significant (P < 0.001). This reflects the importance of social influence and enabling environment, in particular peer pressure, on the smoking habits of the young people.
Smokers are mostly aware of the adverse health consequences of their habit. They seem to ignore the risk, which is best explained as a result of behaviorally induced dissonance, a psychologically unacceptable inconsistency between belief and behavior. 
In the present study, 85.4% of smokers said they had seen cigarette advertisement in the media, whereas 61% nonsmokers said so and this finding was found to be highly significant (P < 0.001). This is despite the fact that tobacco advertising is banned as per Indian Tobacco Control Act, which necessitates strict enforcement of legislation.
It was found that the most common reason for initiating smoking among the youth was influence of friends (86.8%) followed by curiosity, whereas the most common reason for maintenance of smoking among youth was tension (64.8%) followed by fear of withdrawal symptoms (46%).
It can be concluded that smoking parents, peers, cigarette advertisements, and feeling comfortable in social gatherings were significant determinants for smoking and use of other tobacco products among youth and should be a focus for devising any tobacco control strategy among youth. Declaring Chandigarh as a first smoking-free city in the developing world from July 15, 2007, is a key step in tobacco control [ 11] and this study acts as a baseline to see the impact over a period of time.
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