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© 2016 Journal of Indian Association of Public Health Dentistry | Published by Wolters Kluwer ‑ Medknow
80
Reasons for smoking among the teenagers of age 14–17 years in
Vikarabad town: A cross‑sectional study
Md Shakeel Anjum, Madipally Kumar Srikanth, P. Parthasarathi Reddy, M. Monica, K. Yadav Rao, A. Sheetal
Department of Public Health Dentistry, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
Address for correspondence:
Dr. Madipally Kumar Srikanth, Depar tment of Public H ealth Dentist ry, Sri Sai College o f Dental Surgery, Vikarabad ‑ 50 1 101, Telangana, In dia.
E‑mail: srikanthmadipally@gmail.com
ABSTRACT:
Background: Despite widespread knowledge of the health consequences, tobacco use, especially smoking is common globally.
Most of the youngsters become smokers annually and one-third of them are believed to die due to tobacco use. Aim: To assess the
various reasons for smoking among teenagers of age 14–17 years. Materials and Methods: A descriptive cross-sectional survey
was conducted on 384 teenagers to know their views regarding the reasons for smoking habit. A specially designed pretested
questionnaire was used for the survey. Results: Majority of 76.4% of the study subjects agreed that smoking habit gives psychological
pleasure, 77.5% agreed that smoking starts because of friends, and 65.7% felt that smoking starts as an inspiration for outlook
and personality. Conclusion: Various psychological factors, personal factors, and social factors are attached with smoking habit.
Key words:
Causes of smoking, smoking, social factors, teenagers
INTRODUCTION
Smoking is the single most important preventable cause
of death. The teenage is a critical period in the formation
of the smoking habit. Globally, smoking is still on the
rise among teenagers. The habit of smoking is considered
a true drug addiction and is widespread all over the
world.[1] Currently, study outcomes conrm that smoking
is a potential risk factor for health, causing increased
morbidity and mortality that could be prevented.
According to the World Health Organization (WHO), more
than 4 million deaths recorded annually worldwide are
related to smoking habits. Smoking is associated with
a number of diseases and disorders in humans. The
exposure of teenagers in any way to tobacco products
can cause a variety of diseases and could inuence their
psychosocial development. About 4000 children start
smoking each day, whereas 1500 of the adolescents
aged <18 years are regular smokers. Some 545,000
youngsters become smokers annually and one‑third
of them are believed to die due to tobacco use. It is
common that many people start smoking in young ages
and become long‑term addiction to nicotine. There are
various determinants of tobacco use among youth.
These include cultural and religious norms, availability
of different types of tobacco products, tobacco control
policies and strategies, and perhaps most importantly,
tobacco industry behavior to promote tobacco use,
and undercut tobacco control strategies. Advertising,
promotion, and marketing efforts of the tobacco industry
inuence adolescent smoking behavior, often to a greater
extent than it inuences the behavior of adults.
Smoking at public places in India is prohibited in
public since October 2, 2008, under the Prohibition of
ORIGINAL ARTICLE
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DOI:
10.4103/2319-5932.178733
How to cite this article: Anjum M, Srikanth MK, Reddy PP, Monica M,
Rao KY, Sheetal A. Reasons for smoking among the teenagers of age
14–17 years in Vikarabad town: A cross-sectional study. J Indian Assoc
Public Health Dent 2016;14:80-3.
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Anjum, et al.: Reasons for smoking
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Journal of Indian Association of Public Health Dentistry
Vol. 14, Issue 1, | January-March 2016
Smoking in Public Places Rules, 2008 and Cigarettes and
Other Tobacco Products (Prohibition of Advertisement
and Regulation of Trade and Commerce, Production,
Supply, and Distribution) Act, 2003.[2] However, still
smoking among the teenagers has not come down.
There are approximately 120 million smokers in India.
According to the WHO, India is home to 12% of the
world’s smokers.[3] The early initiation of smoking habits
and constant exposure to tobacco products increase the
relative risk factor in the occurrence of serious acute or
chronic health disorders.[4]
Between the age group of 14–17 years, a person is
most likely to get attracted toward smoking habit and
become an addict for the rest of his or her life. This is
the age where the inspiration is at the maximum level,
and adolescents are more conscious of their personality,
styles, and making up their role models. Here in this
study, the reasons of smoking have been investigated
to understand why teenagers take up smoking, which
would be helpful in designing the better antismoking
programs. Hence, this present study aimed to highlight
and also to assess the personal, social, environmental,
and other factors inuencing the initiation of smoking
habit in teenagers of age 14–17 years in Vikarabad town.
MATERIALS AND METHODS
A descriptive cross‑sectional epidemiological survey was
conducted on 384 teenagers among teenagers of age
14–17 years in Vikarabad town of Rangareddy district
of Telangana state over a period of 3 months from July
1, 2013 to September 30, 2013.
List of 24 high schools and 12 intermediate colleges at
Vikarabad town was obtained and using simple random
lottery method, 4 high schools and 4 intermediate
colleges were selected. A sample of 384 teenagers was
obtained based on the prevalence of smoking among
teenagers. Teenagers were included based on the
inclusion criteria that is who are perceiving studies at
Vikarabad town, all the teenagers both smoking and
nonsmoking who were preset on the day of the survey,
and the exclusion criteria were teenagers who were not
willing to participate in the study. Ethical clearance
was taken from the review board of the dental college.
A pilot study was carried out on a sample of 30 subjects
to check the feasibility of the survey and to note any
difculties encountered during the survey. This pilot
study also helped to make modifications wherever
necessary to design the nal proforma which was based
on the literature review.[3,5,6,7,8] The proforma originally
consisted of 20 items which was reduced to 15 items in
the nal proforma after the difculties and the level of
understanding noted among the teenagers. Validity of the
nal proforma was found to be Cronbach’s alpha of 0.72
which is an acceptable level. The questionnaire included
questions on socio‑demographic factors such as age,
gender, their level of education, and questions regarding
the various reasons for smoking among teenagers.
Voluntary willingness from the teenagers to participate
in the study was considered as consent after discussing
in detail about the purpose of the study. In addition,
required permissions were obtained from the respective
school and college principals and parents. Both smokers
and nonsmokers were included as to know the views of
the nonsmokers regarding what are the other possible
reasons for their peer group for picking up smoking and
for the smokers why they have initiated smoking.
Study procedure
The survey is an anonymous collection of opinion with
no direct question involved relating to the consumption
of tobacco or count of cigarettes etc. Data were collected
through the questionnaire given to the teenagers.
Sufcient time was given to the students to ll the
questionnaire and they were collected back on the
same day. The data covering the major aspects were
related to psychological issues, personal perceptions,
concentration, personality impacts, and socializing
activities.
Data analysis
Data were compiled and analyzed for completeness.
Statistical Package for Social Sciences (SPSS ‑ version 20.0)
(IBM Corp. Released 2011. IBM SPSS Statistics for
Windows, Version 20.0. Armonk, NY: IBM Corp) was
used for analysis. Mean standard deviation was used to
describe the demographic details of the study population
and percentages were used for descriptive statistics.
Pearson Chi‑square test was used to compare the
opinions of commuters in receiving oral health messages
based on their gender. P < 0.05 was set for statistical
signicance.
RESULTS
A total of 381 teenagers participated in the survey out of
which, 258 (74.21%) were males and 123 (25.74%) were
females. Among these study population, 101 (26.50%)
were of 9th standard, 102 (26.77%) were of 10th standard,
and 178 (46.77%) were in intermediate education and 39
were smokers, remaining 341 were nonsmokers.
Table 1 shows the percentages of opinions of the
students about the various causes for smoking. Majority
of the study participants agreed that usually smoking
habit starts in youth out of their curiosity (75–94%), as
an inspiration for outlook and personality (65–76%),
and inspired by ads of role models (61–65%) with no
signicant difference observed between smokers and
nonsmokers opinions (P values were 0.057, 0.40,
and 0.22, respectively). Many of the teenagers among
smokers (84%) agree that smoking habit starts because
of friends. High percentage of smoking teenagers (61%)
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Anjum, et al.: Reasons for smoking
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Journal of Indian Association of Public Health Dentistry
Vol. 14, Issue 1, | January-March 2016
agree that smoking is fashionable and there was a
signicant difference (P = 0.05) between smokers and
nonsmokers about their views on youth perception
about smoking habit. Majority of teenagers among
smokers (94%) agree that smoking habit starts because
of their loneliness and boredom, whereas 6% of them
disagree for this statement.
Majority of 86% of the teenagers picked up smoking
because of the mood uctuations or various emotional
feeling and a statistical signicant difference as observed
among the smokers and non‑smokers. Following this,
teenager agreed with the statement that they would like
to smoke while studying which helps them to concentrate
more. Socializations was another reason because of which
teenagers will pick up smoking and there was a statistical
difference between the smokers and nonsmokers (P<0.05).
DISCUSSION
The effects of smoking on health are related to the
occurrence of both acute and chronic disorders. Smoking
can affect almost all the systems in the body, and in
many cases, the disorders are irreversible. The teenage is
a critical phase where they start adapting themselves to
new life style and try to socialize in this modern era. Most
of the smokers start smoking during their adolescence
or early adult years. The earlier they start to smoke, the
more likely they are to become regular smokers.[1] Those
concerned about the health, welfare, and education of
young people should be anxious to nd ways to prevent
them from taking up this habit. A number of factors
inuence an individual to start smoking. This study
aimed to highlight personal, social, and other factors
inuencing smoking in teenagers in Vikarabad town.
In our study, we found that curiosity is one of the major
reasons for the initiation of smoking. Usually, most of
the teenagers starting smoking out of their curiosity to
know what it is and how it is. More than 75% of the study
population agree that smoking habit starts out of their
curiosity. According to Rafael and Zully, the inuence of
the students own classmates is a great inuence for the
beginning of the habit of smoking.[5] Peer inuence was
found to be a strong predictor of smoking initiation in
almost all studies that included these measures.[1] Our
study also found that inuence of friends is the major
reason for initiation of smoking habit and this is similar
to the studies done by Naing et al. in 2004.[1]
According to Rezaei et al. having a smoker family
member, particularly parents, can increase the risk of
smoking among teenagers.[5] Similar results were seen
in the present study were high percentage of the study
group (51.2%) agreed that smoking habit starts because
of smokers in the family. Between the age group of
14–18 years, a person is most likely to get attracted
toward smoking habit and become an addict for the
rest of his or her life. This age represents the growth of
maturity where teens make choices for their life style and
plan where they want to see themselves in the future.[9]
According to this study, majority of the teenagers (66.1%)
agree that smoking habit starts as an inspiration for
outlook and personality and also majority of the study
group agree that smoking habit starts because of ads by
role models such as movie stars and cricketers. According
to the review given by Aristidis et al., commercials
play an important role in the promotion of smoking
behavior.[3] The initiation of smoking is often related
to the inuence and immediacy of advertisements. On
the other hand, this is the age where factors such as
stress, attention disorder, psychological pressures, and
conicts from parents play an important role in impacting
the individual personality, and most of the teens are
seen ghting with these kind of problems, which may
ultimately cause the initiation of the habit. Most of the
study population (65.2%) agree that feelings such as
frustration and anger will trigger them to smoke.
The present study explored various reasons for smoking
such as psychological reasons, personality impact,
inspirations, weight consciousness, and killing appetite.
As we have seen many cases where teens smoke for
either style, causally doing the party or hang‑out with
friends, or sometimes it becomes an important tool for
them to cope up with stress, traumas of life, or attention
disorders. Hence, there are so many factors that motivate
teenagers to become smokers. In most cases, the multiple
factors are playing combined impacts over the subjects
Table 1: Opinions of the students regarding various
reasons for smoking habit
Major reasons for smoking Nonsmokers
(%)
Smokers
opinion (%)
P
Curiosity 75 94 0.059
For outlook and personality 65 76 0.40
Friends 78 84 0.028*
Ads by role models 65 61 0.22
Fashionable 58 61 0.05*
Loneliness and boredom 67 94 0.004*
For a change in their routine lifestyle 53 76 0.28
smokers in the family (father/
brother)
50 61 0.03*
Smoking can takeout psychological
stress
49 56 0.04*
Smoking can ease communication 41 32 0.18
Teens use smoking to kill the
appetite and for weight reduction
41 34 0.01*
Smoking gives a psychological
pleasure
53 84 0.001*
Smoking is a tool for socialization 43 56 0.03*
Feelings such as frustration, anger,
and stress trigger us to smoke
64 86 0.05*
Smoking helps in concentration of
study/of work
42 70 0.00*
*P<0.05 – Pearson Chi‑square test
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Anjum, et al.: Reasons for smoking
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Journal of Indian Association of Public Health Dentistry
Vol. 14, Issue 1, | January-March 2016
creating the high chances of acceptance of smoking
habit. Findings of this study increase the understanding
of parents, teachers, and school/college administration
regarding one of the important issues of teenage, now
they can help their teenagers more effectively to overcome
this bad habit. School can arrange some workshop or
seminar regarding the effects of smoking on physical
health. Effects of smoking can also be added in the
curriculum and teachers can deliver lectures on this
sensitive topic, so teens can rethink about this habit.
The coordinated efforts of public and private organizations,
with the support of health professionals, could contribute
greatly to increase the awareness of the dangers and
to combating the problem. Measures are required from
parents and guardians to take care of teenage problems
and other matters they are dealing with. Interventions
on the family level should be used to prevent the
smoking habit among teenagers. Interventions programs
to encourage behavior modication of teenagers are
also recommended. The continuing scientic research
on smoking and its effects on teenagers assists
signicantly in the evaluation and possible redesign and
implementation of smoking prevention programs. The
government should maintain a strict legal framework that
could protect teenagers from smoking behavior and from
the promotion of smoking advertising, at the same time,
encourage the introduction of antismoking programs.
CONCLUSION
The reasons why teenagers smoke was found to be
multifactorial and the combined impact of all was
creating high chances of smoking among them. Peer
inuence and curiosity about smoking were the main
reasons for smoking followed by teenagers considering
smoking as fashionable. The coordinated efforts of public
and private organizations, with the support of health
professionals, could contribute greatly to increase the
awareness of the dangers and also smoking preventive
programs.
Financial support and sponsorship
Nil.
Conicts of interest
There are no conicts of interest.
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