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Year : 2010  |  Volume : 47  |  Issue : 5  |  Page : 35--38

Need to establish tobacco smoke zones in public places in Kerala

J Muttapppallymyalil1, J Sreedharan1, B Divakaran2,  
1 Research Division, Gulf Medical University, Ajman, United Arab Emirates
2 Department of Community Medicine, Academy of Medical Sciences, Pariyaram Medical College, PO Kannur, Kerala, India

Correspondence Address:
J Muttapppallymyalil
Research Division, Gulf Medical University, Ajman
United Arab Emirates


Background : Second-hand smoke is a grave hazard to both smokers and nonsmokers. Aims : To assess the attitude of general public toward establishing smoke zones in public places. Settings and Design : A cross-sectional survey was conducted among people residing in one randomly selected municipality of Kannur district in Kerala state, India. Materials and Methods : A total of 1000 individuals participated in the study. An open-ended, semi-structured, interviewer-administered questionnaire, which was pilot tested was used to collect information from people willing to participate in the study. Statistical Analysis : Descriptive statistics was used. Statistical analysis was performed by using PASW 17. Results : 73.1% of the total participants indicated a positive attitude toward establishing smoke zones in public places. All female participants and 69.7% of male participants had positive attitude toward establishing smoke zones in public places. Most nonsmokers (83.2%) showed a positive attitude toward establishing smoke zones. A statistically significant (P < 0.001) association was observed between smoking habit and attitude toward establishing smoke zones in public places. Among males, a statistically significant (P < 0.001) association was observed between age and attitude toward the need for smoke zones. As age increased, the attitude toward establishing tobacco smoke zone in public places was found to become more positive. Conclusion : Most of the participants had positive attitude to prohibition of smoking in public places in order to safe guard the public from the harmful effects of Environmental Tobacco Smoke.

How to cite this article:
Muttapppallymyalil J, Sreedharan J, Divakaran B. Need to establish tobacco smoke zones in public places in Kerala.Indian J Cancer 2010;47:35-38

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Muttapppallymyalil J, Sreedharan J, Divakaran B. Need to establish tobacco smoke zones in public places in Kerala. Indian J Cancer [serial online] 2010 [cited 2020 Nov 24 ];47:35-38
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Numerous studies have pointed out that Environmental Tobacco Smoke (ETS) predisposes cardiovascular disease in adults by damaging the endothelium of arteries and decreases the level of high-density lipids in the blood. ETS is also attributed to certain types of cancer, chronic obstructive pulmonary disease, and impairment of lung function. [1],[2],[3],[4],[5],[6],[7] Exposure to second-hand smoke in children can have a greater effect due to higher metabolism and ventilation rates, which lead not only to cancer and cardiovascular disease but also asthma, lower respiratory tract illness, neurologic disorders, and even impairment of cognitive abilities. [8],[9],[10]

ETS has an effect on tobacco users and it can passively affect other people who share the same environment. Over the past years there has been a worldwide step forward to ban smoking in public places, initially in places related to health services and then in private sector places, such as offices, bus stations, and hospitality venues. [11]

Exposure to ETS by non-smoking general public in bus stands, railway stations, market places, movie theaters, and so on is a problem in Kerala, India. Considering the grave adverse health effects that ETS probably has on the general population, the present study assessed the attitude of general public toward establishing smoke zones in public places.

 Materials and Methods

This population-based cross-sectional study was conducted among the general public to assess their attitude toward establishing smoke zones in public places to prevent exposure to ETS. It was conducted in Kannur district in Kerala state of India. Kannur district is situated in the northern part of Kerala and has a population of 2.4 million as per 2001 census. Of the 6 Municipalities in the district, 1 Municipality was randomly chosen to conduct the study. One ward was randomly selected from the identified Municipality. A total of 1000 individuals from all strata of the society above the age of 17 years were enrolled in the study after obtaining verbal consent. To ensure maximum participation, a house-to-house survey was conducted in the evening since household members were mostly available during those hours. An open-ended, semi-structured, interviewer-administered, pilot-tested questionnaire was used to collect information from people who were willing to participate in the study regarding their attitude toward smokers and need to establish smoke zones in public places. For the open-ended questions, space was provided to write-down the replies in verbatim. These were later coded by the data entry operator in consultation with the investigators. Data cleaning, coding, entry, and analysis were conducted under the direct supervision of a Biostatistician. Data files were entered into an Excel spread sheet and exported into statistical software PASW 17 (SPSS, Chicago, Illinois) for data analysis.


A total of 1000 individuals participated in the study, 88% males and 12% females; 41.0% of males and 38.3% of females were in the 25-39 years age group. Male predominance in the study was due to nonparticipation among females. The details are depicted in [Table 1].

Among the participants, 40.5% were educated up to higher secondary school and 38.5% up to high school level. Professionals and Postgraduates comprised only 0.9% of the study group. Only 3.2% participants could not write or read with understanding in any language. With regard to gender and educational status, 41.5% of the males were educated up to the higher secondary school level and 38.8% up to high school level. Whereas among females, 36.7% were educated up to high school level and 33.3% up to the higher secondary school level. The distribution of educational status of the study subjects is given in [Table 1].

With regard to occupation, 49.5% were in the unskilled category, 35.4% in the semi-skilled, 14.2% in skilled, and only 0.9% in the highly skilled category. When analyzing by gender, among males, 43.3% were unskilled workers, 40.1% semi-skilled workers, 15.7% skilled workers, and 0.9% highly skilled workers, whereas among females, 95% were unskilled workers, 3.4% skilled workers, and 0.8% each were semi-skilled and highly skilled workers, respectively. The sociodemographic characteristics are given in [Table 1].

A majority (84%) of the participants were non-smokers, having never smoked any form of tobacco and/or even a few puffs in their life time. None of the females in the study smoked. Among the male respondents, 8.2% were ex-smokers and 10% were current smokers. Current smokers are those who have smoked one or more cigarette(s) in the past 30 days and ex-smokers are those who smoked one or more cigarette(s) daily and not smoked for the past 30 days.

Among all the participants, 73.1% indicated a positive attitude toward establishing smoke zones in public places. Attitude of both genders regarding establishing smoke zones in public places shows that 69.4% of males had a positive attitude toward establishing smoke zones in public places, whereas among females, all opined that establishing smoke zones in public places is essential to prevent exposure to side stream smoke. The details are given in [Table 2].

Of the total respondents, 26.9% had a negative attitude toward establishing smoke zones. Among nonsmokers, 83.2% showed a positive attitude toward establishing smoke zones in public places. It was observed that there is a statistically significant (P P [12],[13],[14],[15],[16],[17],[18] Smoking in public places is dangerous because nonsmokers suffer from the effects of passive smoking by breathing in second-hand smoke from the smokers' cigarettes. Considering all these factors, many nations have banned smoking in public places. New Zealand introduced smoke-free bars and restaurants policy in December 2004. [19] In Europe, Ireland, and Norway have strict regulations for smoke-free areas. [20],[21] In Italy, indoor smoking in public places was banned in 2005, including restaurant and all public and private work places. The law also provides separate and regulated smoking areas. [22]

In the present study, a majority have a positive attitude toward establishing smoke zones in public places. Among males, 69.4% had a positive attitude toward establishing smoke zones in public places and among females, all participants opined that smoke zones in public places are essential. A study conducted in the United States to determine the public opinion regarding smoking restrictions observed that males were more likely to support designated smoking areas compared with females. [23] A study conducted in New Zealand among 200 respondents, majority opined that smoking should be banned in cars when there are passengers. Most smokers in the study used to smoke at home or in their cars rather than in public places. Most of the participants agreed that cars carrying children should be made smoke-free. [24] A study conducted in Taiwan regarding Smoke-Free Restaurant observed that compared with restaurants that are not smoke free, approximately 25% more people had chosen to dine in smoke-free restaurants. The study also reported that around 80% of the people supported smoke-free restaurant legislation. [25] Studies also observed that smoke-free policies increase smoking cessation and reduce tobacco consumption. [26],[27],[28] Most of the studies support the findings of the present study. Ireland became the first country in the world to introduce a nationwide ban on smoking in pubs, restaurants, and other enclosed workplaces and studies revealed that the ban has improved the respiratory health in the country. [20],[21]

The present study observed that more than 80% of non-smokers were having a positive attitude toward establishing smoke zones in public places. A study conducted in Australia observed that most of the participants were supporting smoking restrictions in public places. Non-smokers were more likely than smokers to have a positive attitude toward smoke-free policy.

A study in Italy reported that 90.4% were in favor of smoke-free areas in public places, such as cafes and restaurants, after the implementation of smoke-free public areas. The study also reported that the support for smoke-free policies increased once the policies were introduced and a significant fall in cigarette sale was also observed. [22] After the implementation of smoke-free bars and restaurants policy, public support for smoke-free bars increased from 56% to 69%. Moreover, the proportion of smokers who smoked more than usual at bars and nightclubs became halved. [19]


The study concludes that public is more in favour of separate smoke zones, and hence more tobacco control activities should be undertaken to attract public attention, enhance participation, and create an environment for establishing smoke zones in public places. To tackle the problem of sidestream smoke, besides societal support one needs to convince the policy makers and implementing authorities to initiate measures in this regard. This study is also in line with the 2010 World No Tobacco Day (31 May) theme "Smoke-free inside."


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