|BRIEF RESEARCH ARTICLE
|Year : 2014 | Volume
| Issue : 1 | Page : 50-53
A study on smoking and associated psychosocial factors among adolescent students in Kolkata, India
Nilay Nilay Bagchi1, Samrat Ganguly2, Sumita Pal1, Sukanta Chatterjee3
1 Assistant Professor, Department of Pediatrics, Medical College, Kolkata, West Bengal, India
2 Junior Resident, Department of Pediatrics, Medical College, Kolkata, West Bengal, India
3 Professor, Department of Pediatrics, KPC Medical College, Kolkata, West Bengal, India
|Date of Web Publication||5-Mar-2014|
Petuya Das Para, P.O. Subhas Gram, P.S. Baruipur, Kolkata - 700 147, West Bengal
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Tobacco use among school children and adolescents is an increasing problem world-wide, particularly in the developing countries. A cross-sectional observational study was carried out in six co-educational high schools in Kolkata, West Bengal among 526 students of 15-19 years to determine the prevalence of smoking and to find out any difference among the smokers and non-smokers regarding factors related to family relations, peer group and personal characteristics. The overall rate of smoking was found to be 29.6%, mean age of initiation of smoking was earlier in males. Among smokers 75% students started smoking by 15 years. Smoking of father and peer group, family conflict and pornography addiction were found to have significant association with smoking of students. Early school health based interventions addressing these factors might help in effectively tackling this problem.
Keywords: Adolescent, Prevalence, Smoking, Tobacco
|How to cite this article:|
Bagchi NN, Ganguly S, Pal S, Chatterjee S. A study on smoking and associated psychosocial factors among adolescent students in Kolkata, India. Indian J Public Health 2014;58:50-3
|How to cite this URL:|
Bagchi NN, Ganguly S, Pal S, Chatterjee S. A study on smoking and associated psychosocial factors among adolescent students in Kolkata, India. Indian J Public Health [serial online] 2014 [cited 2019 Sep 19];58:50-3. Available from: http://www.ijph.in/text.asp?2014/58/1/50/128168
Tobacco use in different forms is one of the most common substance abuse indulged by adolescents world-wide. Nearly 6 million deaths due to tobacco use occur every year, which may increase to 8 million deaths/year by 2030.  Of these, 70% deaths will occur in the developing countries, mainly China and India. , Young people are the most vulnerable segment and adolescence is found to be the most susceptible time for initiating tobacco use.  It was estimated in 1999-2001 that approximately 5500 adolescents, some as young as 10 years old start tobacco use every day in our country and nearly 4 million young people under the age of 15 years are already using tobacco regularly. , In India, the current prevalence of any form of tobacco use among school-going adolescents (aged 13-15 years) has been reported to be 17.5% (2.7-63%). 
Various factors influence tobacco use among adolescent students. Addiction to tobacco products and other substance of abuse among family members and peer groups, family conflicts, poor school performance, truancy and school dropouts has been found to be associated with smoking at an early age. ,,,
We undertook this study to determine the prevalence of tobacco use among adolescent students in Kolkata and determine the different factors related to the parents, peer group, family dynamics and personal characteristics that influence this habit.
This cross-sectional, descriptive, observational study was carried out in six co-educational higher secondary schools of Kolkata, where school-health activity was being conducted by the Adolescent Health Clinic of Medical College, Kolkata. Regular visits to these schools were made as part of routine health care activity from the clinic. Institutional Ethical Committee Clearance and permission from the school authority were obtained. The study was carried out among students of class-IX to class-XII of the said schools from August 2011 to November 2011 after assuring anonymity and taking consent from the parents. No sampling was done among the students in each class to include as many subjects as possible, within a limited resource. All students aged 15-19 years, who were present during the school visits for the study and gave their consent were included in the study. Those students who did not give consent, returned torn or incomplete questionnaire were excluded from the analysis. A total of 682 students in the age group of 14-19 years were initially chosen of which 81 students did not give consent and 28 students did not participate. Questionnaires were distributed in the rest 573 students, of them 47 returned incomplete and damaged questionnaires. The final analysis was performed among the 526 students.
A pre-designed, pre-tested, semi structured, self-reporting questionnaire in regional language derived from standard questionnaire used in Adolescent Health Clinic, Medical College Kolkata was used.  During the school visits, copies of the questionnaire were distributed to the students after proper briefing for filling in the class room.
We collected information regarding particulars of the adolescents (age, sex), age at initiation of smoking, knowledge of ill-effects of tobacco use, perceptions of the adolescents about factors related to family - what the adolescents think about the affection of their parents, whether they feel that their parents offer help during time of stress, whether they inform parents about friends and pocket money, parental conflicts, smoking and alcohol addiction of parents, factors related to peer group and personal characteristics - smoking and alcohol addiction of friends and self, sexual exposure of friends and self, the adolescent's interest about school and concern for study, and involvement in physical activity. We used the following definitions of the US Centers for Disease Control and Prevention for categorizing students with smoking habit. 
- Never smokers - Students who have never smoked a cigarette or who smoked fewer than 100 cigarettes in their entire lifetime.
- Former smokers - Students who have smoked at least 100 cigarettes in their lifetime, but say they currently do not smoke.
- Non-smokers - Students who currently do not smoke cigarettes, including both former smokers and never smokers.
- Current smokers - Students who have smoked 100 cigarettes in their lifetime and currently smoke cigarettes every day (daily) or some days (non-daily).
Though this classification was developed for adults, we used this for the present study as there are no specific definitions for adolescents and children. Students were asked about the smoking habit of father which was defined as daily smoking of at least one cigarettes/bidi.
Data thus obtained were analyzed by IBM SPSS Statistics
(Version 19.0.0; SPSS Inc, Chicago, IL). Mean and standard deviation (SD) values were determined, P values and odds ratio determined to find out any difference between the smoking and non-smoking groups of students regarding the different factors.
Our study population consisted of 363 (69%) male and 163 (31%) female students. The male: Female ratio in the study population reflected the existing ratio of about 2:1 in the classes. 134 (37%) male students and 22 (13.5%) female students were found to be current smoker as per the previous mentioned definitions. No students qualified for the category of former smoker. Hence rest of the students were under the category of never smoker, mentioned henceforth as non-smokers. The data collected from the questionnaire were correlated among the smoker and non-smoker groups with Chi-square test.
The results are noted in [Table 1] and [Table 2].
|Table 1: Comparison of perception of students about parents and other family factors among smokers and non-smokers (n =526)|
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|Table 2: Comparison of peer and personal characteristics among smokers and non-smokers|
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Among the parental factors reported by the children, significant difference between the "smoker" and "non-smoker" groups were observed in case of feeling the affection of both parents, mother's assistance in stress, informing mother about leisure time and feeling fathers affection. Among the family factors, significant difference were observed in case of smoking habit of father, family concern about study and conflict among parents. Among peer group factors only smoking among peer group was significantly different among the two groups. Pornography addiction was the sole student factor found to be different statistically.
Mean age of initiation of smoking was 13.46 years (SD: 2.3) among boys and 14.73 years (SD: 2.1) among girl students, overall it was found to be 13.64 years (SD: 2.4). Thus the boy students started smoking about 1 year earlier than the girl students. Nearly 50% of the students started smoking by 13 years and the percentage increased to 75% of total by 15 years of age. Knowledge about adverse effects of smoking was reported by similar number of students among the two groups (P = 0.1).
Various socio-economic conditions, exposure to childhood abuse, violence within family, depressive symptoms, stressful life events, poor academic performance, negative peer influence, etc., are significantly associated with increased risk of regular smoking and associated high risk behavior, with parental support acting as a protective factor. ,,,,,
Kapoor et al. in their study conducted in Haryana showed that male sex, age >15 years, smoking by father, mother, sister and friends were significantly associated with adolescent smoking.  The study found the prevalence of current smoking was 7.1% and 44% of the students started smoking when they were 10-15 years of age. Sinha et al. in their study carried out in eight north-eastern states of India found that current tobacco use (any product) ranged from 63% (Nagaland) to 36.1% (Assam). This study also observed positive association between tobacco use by parents and close friends with tobacco use by the students. They also found that over 65% of users reported initiation at 10 years of age or earlier.  Narain et al. in their study conducted in Noida, India found any kind of tobacco use among 11.2% of students. Mean age of initiation of these habits was around 12.4 years.  In another study carried out in Goa, Pednekar and Gupta found 'ever tobacco' usage in 4.5% students and tobacco use by parents and friends to be associated strongly with tobacco use by the students. 
In present study, the prevalence of smoking was found to be 37% among males and 13.5% among females, with overall prevalence was 29.6%. We found that smoking by father and peer group and conflict among parents were positively associated with smoking by students, whereas feeling of father's affection, mother's assistance during stress and adolescents reporting to their mother of how they spent leisure time- were negatively associated with their smoking habit. The present study found the average age of initiation of smoking was 13.64 years (range from 8 to 19 years, SD: 2.4), with male students starting at a mean age of 13.46 years, which was 1.2 years earlier than the female students with mean age of initiation 14.7 years. These findings are comparable to similar studies carried out in different regions of India. We did not found any difference in knowledge about the ill-effects of smoking among the smoker and the non-smoker adolescents.
Alcohol abuse has been found to have strong association with smoking and substance abuse in adolescent in other studies. , However, present study failed to demonstrate significant difference of reportage of alcohol addiction in family, peer group or of self among smokers and non-smokers. The stigmata associated with alcohol addiction in our socio-economic group may have caused under-reporting from the students.
Drawbacks of the present study included recall bias, conscious falsification by the subjects, small number of subjects, lack of external validity. Despite these shortcomings, this study found some important and often neglected correlates of adolescent smoking behavior that needs to be addressed.
In conclusion, several factors related to family and peer groups influence smoking by adolescents from an early age. Joint efforts from family, school, social welfare groups are needed to address these factors for effective prevention, in addition to raising awareness against tobacco use among the school students.
| Acknowledgments|| |
We sincerely thank the Adolescent Health Clinic and the Department of Biochemistry of Medical College Kolkata for their support to carry out the study.
| References|| |
|1.||World Health Organization (WHO). Tobacco Free Initiative. Media Centre Fact Sheets. Tobacco; [about 2 screens]. Available from: http://www.who.int/mediacentre/factsheets/fs339/en/index.html. [Last cited on 2012 May 12]. |
|2.||World Health Organization. Making a Difference. World Health Report, 1999. Geneva: World Health Organization; 1999. |
|3.||Gupta PC, Ball K. India: Tobacco tragedy. Lancet 1990;335:594-5. |
|4.||National Sample Survey Organization (NSS). A note on consumption of tobacco in India, NSS 50 th round (1993-1994). Sarvekshana J Natl Sample Surv Organization 1998;21:69-100. |
|5.||Patel DR. Smoking and children. Indian J Pediatr 1999;66: 817-24. |
|6.||Reddy KS, Arora M. Tobacco use among children in India: A burgeoning epidemic. Indian Pediatr 2005;42:757-61. |
|7.||Simantov E, Schoen C, Klein JD. Health-compromising behaviors: Why do adolescents smoke or drink? Identifying underlying risk and protective factors. Arch Pediatr Adolesc Med 2000;154:1025-33. |
|8.||Karp I, O′Loughlin J, Paradis G, Hanley J, Difranza J. Smoking trajectories of adolescent novice smokers in a longitudinal study of tobacco use. Ann Epidemiol 2005;15:445-52. |
|9.||Audrain-McGovern J, Rodriguez D, Tercyak KP, Cuevas J, Rodgers K, Patterson F. Identifying and characterizing adolescent smoking trajectories. Cancer Epidemiol Biomarkers Prev 2004;13:2023-34. |
|10.||Stanton WR, Flay BR, Colder CR, Mehta P. Identifying and predicting adolescent smokers′ developmental trajectories. Nicotine Tob Res 2004;6:843-52. |
|11.||Adolescent Health Clinic. Adolescent health screening questionnaire (FAPS). Available from: http://www.ahckolkata.org/questionnaire.html. [Last cited on 2012 May 15]. |
|12.||Schoenborn CA, Adams PE. Health behaviors of adults: United States, 2005-2007. Vital Health Stat 10 2010;245; 1-132. |
|13.||Kapoor SK, Anand K, Kumar G. Prevalence of tobacco use among school and college going adolescents of Haryana. Indian J Pediatr 1995;62:461-6. |
|14.||Sinha DN, Gupta PC, Pednekar MS. Tobacco use among students in the eight North-eastern states of India. Indian J Cancer 2003;40:43-59. |
|15.||Narain R, Sardana S, Gupta S, Sehgal A. Age at initiation & prevalence of tobacco use among school children in Noida, India: A cross-sectional questionnaire based survey. Indian J Med Res 2011;133:300-7. |
|16.||Pednekar MS, Gupta PC. Tobacco use among school students in Goa, India. Indian J Public Health 2004;48:147-52. |
[Table 1], [Table 2]
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