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|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
J S Thakur
PGIMER School of Public Health, Chandigarh
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.
|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;47:59-62
|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 Feb 27 ];47:59-62
Available from: http://www.indianjcancer.com/text.asp?2010/47/5/59/63871
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.
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 P 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 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 P P P P P 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 
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 [ 11] and this study acts as a baseline to see the impact over a period of time.
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