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24
Journal of Indian Association Of Public Health Dentistry
Vol. 13, Issue 1, | January-March 2015
Prevalence of tobacco use among 15-20 years old college
students in Bengaluru city
Vasudha Sharma, S. S. Hiremath1, Manjunath Puranik2, Shweta Somasundara
Department of Public Health Dentistry, Rajarajeswari Dental College and Hospital, 1Department of Public Health Dentistry, Oxford Dental
College and Hospital, 2Department of Public Health Dentistry, Government Dental College and Research Institute Dental College and
Hospital, Bengaluru, Karnataka, India
Address for correspondence:
Dr. Vasudha Sharma, Dep artment of Pub lic Health Dentistr y, Rajaraje swari Dental Co llege and Hospi tal, No. 207, Kambip ura, Kumbal Godu, My sore
Road, Ben galuru, Karnat aka, India. E-mail: vashu77@gmail.com
ABSTRACT:
Introducon: Tobacco use in children and adolescents is reaching pandemic levels. The World Health Organization predicts that
India will have the fastest rate of rise in deaths attributable to tobacco in the productive years of adult life, as a consequence of
an addiction acquired in youth. Materials and Methods: A cross-sectional questionnaire study based on global youth tobacco
survey was undertaken to study the prevalence of tobacco use among 15-20 years old college students. A simple random sampling
method was used to select the students from Government and Private schools and Colleges in Bengaluru city. Results: In the study
population of 2399 in the age group of 15-20 years, 307 (12.8%) subjects reported use of cigarettes among whom 176 (7.3%)
reported current use and 240 (10%) reported ever use of smokeless tobacco. Majority 226 (73.6%) belonged to private institutions
and 81 (26.4%) to government institutions. About 41 (1.7%) were daily smokers. Conclusion: Prevalence of smoking was much
higher among the private institution students as opposed to students of government institutions; also, it was observed that the
percentage of smokeless tobacco users were higher in this age group when compared to cigarette smokers.
Key words:
Global youth tobacco survey, smokeless tobacco use, tobacco use
INTRODUCTION
Tobacco use is a serious public health challenge in
several regions of the world. According to estimates
made by the World Health Organization (WHO), currently
about 5 million people die prematurely every year in
the world due to the use of tobacco, mostly cigarette
smoking. By 2030, it would double to 10 million deaths
every year, with about 7 million of the deaths taking
place in developing countries. India will have the fastest
rate of rise in deaths attributable to tobacco and many
of these will occur in the productive years of adult life,
as a consequence of an addiction acquired in youth.[1]
The global literature is only of limited help in assessing
the problem of tobacco use in India since the dominant
and the most researched form of tobacco use globally is
cigarette smoking. In India, cigarette smoking comprises
a small part of the tobacco smoking problem and a minor
part of the overall tobacco problem, a major problem
being beedi smoking, and the oral use of smokeless
tobacco products. Adolescents are the most vulnerable
population to initiate tobacco use. However, it is now well
established that most of the adult users of tobacco start
tobacco use in childhood or adolescence.[2]
Many studies across the world and in the country have
focused on 13-15 years age group using global youth
tobacco survey (GYTS) while global adult tobacco survey
has been used for adult population. The present study
was an attempt to specically study the pattern tobacco
use both smoking and smokeless forms among the
15-20 years old as 15 years is a transition age group
from school to college, which offers more freedom than
rigid school systems and 17 years is transition from
junior college to senior college in our country. However,
very few studies have been conducted with respect to
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DOI:
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ORIGINAL ARTICLE
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Sharma, et al.: Prevalence of tobacco use in Bengaluru city
25
Journal of Indian Association Of Public Health Dentistry
Vol. 13, Issue 1, | January-March 2015
prevalence of use of tobacco in any form among especially
college going students in our country. Hence, the aim of
the study was to assess the prevalence of smoking and
smokeless tobacco use among 15-20 years old college
students in Bengaluru city.
MATERIALS AND METHODS
This was a cross-sectional questionnaire-based study
conducted on 15-20 years old college students in
Bengaluru city. List of colleges was obtained from The
Directorate of Pre University Education Bengaluru and
collegiate education.
Colleges in Bengaluru are divided into north and south
zones with 306 colleges in south and 236 colleges in north
zone respectively. From north Zone, 4 Government and
1 Private College and from south zone, 3 Government
and 3 Private Colleges offering pre university and degree
courses were selected randomly until the required sample
size was satised. The study participants were selected
using simple random sampling from Ist year, IInd year pre
university and Ist, IInd and IIIrd year degree students to
suit the age group of the study.
A pilot study was conducted, and the population
proportion of tobacco use was estimated at 40%. Based
on this, sample size was estimated at 2304 subjects. It
was then rounded off to 2400 study subjects.
Ethical clearance was obtained by the institutional ethical
committee. Necessary permissions were obtained from
Board of Pre-University and collegiate education and the
study and colleges. The required permissions to conduct
the study were taken from the college authorities.
The study participants were allotted a number and
were asked not to disclose their name to protect the
condentiality of the information provided. Demographic
information regarding the age, sex, education, parental
education level, occupation and socioeconomic status
was collected. Information regarding smoking and use
of smokeless tobacco among students were ascertained
using a questionnaire derived from the GYTS[3] and
modied to suit the present study. The students were
asked to assemble in a classroom and explained the
purpose of the study. The questionnaire was then
administered and was collected after they had completed
answering all questions.
Ascertainment of tobacco exposure was done using the
terminologies suggested by GYTS. Ever users of cigarettes
or ever smokers were dened as those who reported
having smoked >100 cigarettes during their lifetime.
Current smokers were dened as those who reported
having smoked >100 cigarettes during their lifetime and
who currently smoked every day or some days. Never
smokers were dened as those who reported not having
smoked >100 cigarettes during their lifetime. Ever use
of tobacco products other than cigarette was dened as
having used these products at least 20 times in their life.
The category of current smokers in this study included
those who reported to be occasional smokers, frequent
smoker and daily smokers.
Descriptive statistics was used to analyze the data.
Statistical analysis was performed using SPSS version 14
(spss inc. Chicago, USA).
RESULTS
Demographic prole
Table 1 shows the distribution of participants in
different age groups. Of 2400 students, one student did
not respond and hence statistical analysis and result
reporting was done using the final sample of 2399
students: 1391 (57.9%) belonged to private institution
and 1009 (42.04%) to government institutions. About
1366 (57%) were males, and 1033 (43%) were females.
Prevalence of smoking in various groups
Prevalence of ever use
In the study population of 2399, 307 (12.8%) subjects
reported ever use of cigarette, 262 (85.3%) were males and
45 (14.9%) were females, 226 (73.6%) belonged to private
institutions and 81 (26.4%) to government institutions
Prevalence of current use of cigarettes
In the present study, 176 (7.3%) reported current use
of cigarette. Among the 176 students who reported
current use, 123 (5.1%) were ex-smokers, 112 (4.7%)
were occasional smokers, 23 (1%) were frequent smokers
and a total of 41 (1.7%) reported to be daily smokers.
Among the 1367 males, 16% reported ever use of cigarette
and among the 1033 females, 4.5% reported ever use
of cigarette. Table 2 shows the distribution of current
smokers with respect to gender.
Table 1: Demographic prole
Age in
years
n=2400 Education n (%) College n (%)
PUC Degree Government Private
15 106 106 (9) ‑82 (8.1) 24 (1.7)
16 410 405 (34.5) 5 (0.4) 212 (21) 198 (14.2)
17 734 530 (45.1) 204 (16.7) 243 (24.1) 491 (35.3)
18 608 119 (10.1) 489 (39.9) 233 (23.1) 375 (27)
19 300 11 (0.9) 289 (23.6) 103 (10.2) 197 (14.2)
20 241 3 (0.3) 238 (19.4) 135 (13.4) 106 (7.6)
Did not
respond
01 ‑ ‑ ‑ ‑
Gender
Male 1366 (57) 765 (65.1) 601 (49.1) 616 (45) 751 (55)
Female 1033 (43) 410 (34.9) 623 (50.9) 393 (38) 640 (62)
Total 2399 (100) 1175 (48.9) 1224 (50.8) 1009 (42) 1391 (58)
PUC ‑ Pre‑university college
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Sharma, et al.: Prevalence of tobacco use in Bengaluru city
26
Journal of Indian Association Of Public Health Dentistry
Vol. 13, Issue 1, | January-March 2015
Distribution of study population with respect to current use
of cigarettes and age
Out of 176 current users of cigarette, 2 (1.1%) students
were of the age 15 years; 20 (11.3%) were 16 years old;
about 41 (23.2%) were 17 years of age; 48 (27.2%) were
18 years of age; 30 (17%) students were 19 years of age
and 35 (19.8%) were 20 years old. Of the 41 subjects
who were daily smokers, 1 (2.4%) student was of the
age 15 years; 1 (2.4%) was 16 years old; 7 (17.1%) were
17 years of age; 16 (39%) subjects were 18 years of age
and 12 (29.3%) were 20 years of age.
Distribution of study population with respect to age, gender
and current use of cigarettes
Out of 147 males who were current users of cigarette,
2 (1.3%) students were of the age 15 years, 15 (10.2%)
were 16 years old, about 36 (24.4%) were 17 years
of age, 37 (24.5%) were 18 years of age, 26 (17.6%)
students were 19 years of age and 31 (21%) were
20 years old.
Out of 29 females who were current users of cigarette,
5 (17.2%) were 16 years old, about 5 (17.2%) were
17 years of age, 11 (37.9%) were 18 years of age,
4 (13.7%) students were 19 years of age and 4 (13.7%)
were 20 years old.
Distribution of study population with respect to age of
initiation of the habit among pre university and degree groups
Among the 307 ever smokers, 89 (28.9%) reported
smoking before the age of 15 and 218 (71.1%) reported
smoking after the age of 15 years. Table 3 shows the age
of initiation among ever smokers.
Prevalence of use of tobacco products other than
cigarettes
Distribution of users of tobacco products other than
cigarettes among the pre university and degree group
Among the total population of 2399 students, 240 (10%)
of the students have reported ever use of tobacco
products like guthka, khaini, snuff, hookah. Among
the 240 students who reported ever use, 106 (44.1%)
belonged to the pre university category and 134 (55.8%)
were degree students.
Among the 176 who reported current use of cigarettes,
51 (28.9%) reported ever use of tobacco products like
guthka, khaini, snuff, hookah Furthermore, it was
observed that 14 (34%) of the daily smokers reported
concurrent ever use of smokeless tobacco and among the
students who reported no use of cigarettes, 153 (6.3%)
reported use of only smokeless tobacco. Table 4 shows
the distribution of ever users of tobacco products other
than cigarettes among students in different college
categories. Table 5 shows the ever use of tobacco
products other than cigarettes among students who
reported to be current smokers.
DISCUSSION
Tobacco use is one of the major preventable causes of
premature death and disease in the world. The WHO
estimated that the proportion of deaths that result from
tobacco-related diseases will rise in India, from 1.4% of all
deaths in 1990 to 13.3% of all deaths in 2020. In India’s
case, the population is expected to grow by about 300
million between 2000 and 2020.[1] Most of the expansion
will occur in the age group of 15–20 years.
Prevalence of ever users and current users
In the present study, among the total population,
176 (7.3%) reported current use of cigarettes, 147 (6.1%)
males and 29 (1.2%) females reported current cigarette
use. A study in Haryana in 1995 among adolescents[4]
and 2002 among college students[2] reported 7.1%, which
is similar to the present study. Whereas, according
to GYTS – India 2002–2004,[1] prevalence of current
smoking among students was 8.3%, study among
college students in Andhra Pradesh,[5] prevalence of
current smokers was 8.2%, CDC-MMWR[6] reported
9.2%, Western Nepal 2007[7] reported 9.4% and in a
study in Greece[8] in 2007, 10.4% students were current
Table 2: Distribution of current smokers with respect
to gender
Current smokers Gender Total (%)
Male Female
Occasional smokers 90 (61.2) 22 (75.8) 112 (4.7)
Frequent smokers 22 (14.9) 1 (3.4) 23 (1)
Daily smokers 35 (23.9) 6 (20.6) 41 (1.7)
Total (%) 147 (83.5) 29 (16.4) 176 (7.3)
Table 3: Distribution of ever users of cigarettes with
respect to age of initiation of the habit and education
category
Age of initiation of the
habit among ever smokers
<15 years >15 years Total
PUC students 43 (48.3) 80 (36.7) 123 (40)
Degree students 46 (51.6) 138 (63.3) 184 (59.9)
Total (%) 89 (28.9) 218 (71.1) 307 (100)
Table 4: Distribution of students reporting ever use
of tobacco products other than cigarettes with and
education category and college category
Ever use of tobacco
products other
than cigarettes
Education College
PUC Degree Government Private
Did not respond 1 (0.1) 3 (0.1) 1 (0.1) 2 (0.1)
Yes 106 (9) 134 (11) 93 (9.2) 147 (10.6)
No 1068 (90.9) 1087 (88.9) 915 (90.7) 1240 (89.3)
Total 1175 (48.9) 1224 (50.9) 1009 (42) 1389 (58)
PUC ‑ Pre‑university college
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Sharma, et al.: Prevalence of tobacco use in Bengaluru city
27
Journal of Indian Association Of Public Health Dentistry
Vol. 13, Issue 1, | January-March 2015
smokers. Study in Maharashtra 1998[9] reported 10.6%,
country wide study in 2004[10] reported 19.4%, Youth
tobacco surveillance New York[11] reported 16.3% and
Georgia youth tobacco survey[12] reported 14% which is
much higher, this can be attributed to sociocultural and
geographic differences.
Among the 307 ever users, the majority 226 (73.6%)
belonged to private institutions and 81 (26.4%) to
government institutions, whereas in a study in Chennai
in 2006[13] reported that smoking was more in the
corporation students which is not in line with the
present study. Similarly, a study in Delhi and Chennai
2004[14] has reported that the prevalence of ever smoking
was 18.9% in government sector when compared to
12.2% in private sector which is again, not in line with
this study. Among the 176 current smokers, 132 (72%)
belong to private institutions and 44 (18%) belong
to government institutions. Of the 41 daily smokers,
25 (60.9%) are from private institutions and 16 (39.9%)
are from government institutions. Whereas in a study in
Bombay in 1991[15] reported that 22.5% of the smokers
belonged to private English institution when compared
to 13.8% in the municipal sector, which is less than the
present study.
Age of initiation
In the present study, nearly 29% reported initiation of
ever use of cigarette before the age of 15 similar to other
studies, however, the age range of initiation spans from as
low as 10 years in certain studies to as high as 18. Among
the 307 ever users 89 (28.9%) reported smoking before
the age of 15 and 218 (71.1%) reported smoking after the
age of 15 years whereas in the study in Western Nepal
2007[7] 89.6% of ever smokers had initiated smoking
between the ages 12 and 18 years with a median age of
16 years and 30.2% of ever smokers initiated before the
age of 15 years. In a study in Uganda 2004,[16] 37.8% had
smoked before the age of 10 years. Whereas a study in
Harayana in 1995 among adolescents[4] reported that the
majority of smokers had started at the age of 10-15 years
and almost 36% had smoked before the age of 10 years.
Whereas study in 2002 among college students,[2]
reported that 40% of students, majority males had started
the habit between the ages of 10 and 15 years. However,
in a study in Karachi 2007[17] reported that the mean age
of starting cigarette in males was 13.1 years.
There has been reporting of different ages with respect
to age of initiation in various studies. This may be
on account of the various age groups used in these
studies and also to the cultural differences in the study
populations of these studies. There may be differences
also due to the fact that the age of initiation again is
self-reported by the participant.
Age of current smokers
Out of 176 current users of cigarette, 2 (1.1%) students
were of the age 15 years, 20 (11.3%) were 16 years old,
about 41 (23.2%) were 17 years of age, 48 (27.2%) were
18 years of age, 30 (17%) students were 19 years of age
and 35 (19.8%) were 20 years old.
On the whole, among the current users, use of cigarettes
was seen more in the age group of 17–20 years. However,
a study in Alaska 2004[18] reported than cigarette smoking
seems to peak at the ages from 18 to 24 years.
Prevalence of use of tobacco products other than
cigarettes
In the present study, the overall prevalence of smokeless
tobacco use is about 10%, there was a wide variation
of percentage of tobacco products other than cigarettes
use, ranging from 10% to as high as 55.6%. According
to the GYTS – India 2002–2004,[1] 14.6% were the
current smokeless tobacco users ranging from 2% in
Himachal Pradesh to 55.6% in Bihar. In the GYTS 2002
in Uttaranchal,[19] the prevalence was 17.6%, higher than
the present study; in a study in Jamnagar 2007,[20] the
prevalence of smokeless tobacco use among 17–19 years
age group was 36.26%, much higher than the present
study. Maharashtra 1998[9] study reported 6.7%, A study in
Mumbai 2006[21] reported overall smokeless tobacco use as
10% which is comparable to the present study. In a study
in Greece[8] in 2007, the prevalence of smokeless tobacco
use was 10.9%.Whereas, the prevalence of smokeless
tobacco in Canada 2004[22] was 14%. Tobacco use survey
in high school students in US[6] showed the prevalence
to be 12.8%, Karachi 2007[17] was 16.1%. According to
Florida youth tobacco survey-2006,[23] current smokeless
tobacco use among high school students is about 6%,
Youth Tobacco Surveillance, New York[11] reported 3.2%,
CTUMS Ontario[24] reported use among 15-19 years old
youth as 7%, Western Nepal 2007[7] study reported 6.5%,
which is lower than the present study.
Table 5: Distribution of current users of cigarette reporting ever use of tobacco products other than cigarettes with
education category and college category
Ever use of tobacco products
other than cigarettes
Current use of cigarette (%) Total (%)
Never user Ex-smoker Occasional smoker Frequent smoker Daily smoker
Did not respond 4 (0.1) 0 0 0 0 4 (0.1)
Yes 153 (7.3) 36 (29.3) 27 (24.1) 10 (43.5) 14 (34.1) 240 (10.0)
No 1943 (92.6) 87 (70.7) 85 (75.9) 13 (56.5) 27 (65.9) 2155 (87.7)
Total 2100 (87.5) 123 (5.1) 112 (4.7) 23 (0.9) 41 (1.7) 2399 (100)
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Sharma, et al.: Prevalence of tobacco use in Bengaluru city
28
Journal of Indian Association Of Public Health Dentistry
Vol. 13, Issue 1, | January-March 2015
It was also observed that the percentage of smokeless
tobacco users was slightly higher in the students from
the private institution when compared to government,
also was higher among the degree students than
pre-university students.
The prevalence of smokeless tobacco use among these
students was much higher than use of cigarettes. Some of
the reasons for this trend may be that smokeless tobacco
consumption can be done more discreetly as there is no
associated smoke or odor, can be used inside classrooms.
Comparatively more economical compared with cigarettes
as a single packet can be used over an entire day. The
small pouches can be concealed easily and also easier
to hide the habit from family members.
Limitations
Global youth tobacco survey is limited to students
especially in the ages 13–15 years and most of the data
are available from sporadic surveys is in this age group.
The present study was conducted on age groups 15
through 20 years and hence comparability was limited.
Furthermore, in India, there is a huge dropout rate in
education after schooling, it is important that tobacco
use survey must be extended to those youth who do not
attend schools or colleges.
Second, these data apply only to youths who were in
college on the day of the survey and who completed
the survey. However, student response rates were
high suggesting that bias attributable to absence or
nonresponse was limited. Finally, data were based on
the self-report of students, who might underreport or
overreport their behaviors or attitudes. The extent of this
bias cannot be determined from these data.
CONCLUSION
The gloomy predictions about the growing magnitude
of tobacco threat to India relate to a rise both in the
proportion of deaths attributable to tobacco and in the
absolute number of persons who consume tobacco.
The age group of 15–20 encompasses most of the high
school/pre university and degree students, which is
most vulnerable to acquiring and continuing the tobacco
addiction. It was observed in this study among the
176 current smokers, 72% belong to private institutions
and 18% belong to government institutions. Of the
41 daily smokers, 60.9% are from private institutions and
39.9% are from government institutions. The prevalence
of smoking was much higher in the private institution
as opposed to government institutions; this may be
attributed to greater nancial independence of students
in private institutions, prevalent peer pressure. Also, it
was observed that the percentage of smokeless tobacco
users were higher in this age group as compared to
cigarette smokers.
Therefore, it is necessary to monitor the trends in age
of initiation as well as the prevalence of tobacco usage
patterns in this age group of college going students at
the national level. Measures to curb the increasing use
of tobacco among the youth have to be enforced more
strictly.
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How to cite this article: Sharma V, Hiremath SS, Puranik M, Somasun-
dara S. Prevalence of tobacco use among 15-20 years old college students
in Bengaluru city. J Indian Assoc Public Health Dent 2015;13:24-9.
Source of Support: Nil, Conict of Interest: None declared.
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