Prevalence of tobacco use among young adult males in India: a community-based epidemiological study

Tobacco Use Among College Students Across Various Disciplines in Kerala, India

Background

Tobacco use is a major public health concern in India. Its use in young people is linked to increased severity, longer duration, and reduced efforts to seek treatment for tobacco use. A significant proportion of young people are enrolled in colleges, and early prevention during this period has better effectiveness. There is preliminary evidence that prevalence may vary across courses even among students of the same sociocultural background. Hence, we compared the prevalence and correlates of tobacco use among college students enrolled in five common streams of collegiate education (medical, nursing, engineering, arts/science and others, law/fisheries) in Kerala, India.

Methods

5784 college students from 58 colleges (medical, nursing, engineering, arts, and law and fisheries) selected by cluster random sampling in the district of Ernakulum, Kerala, completed a self-administered questionnaire incorporating standardized instruments. R software was used for analyses. Lifetime prevalence and severity of tobacco use were determined. Sociodemographic variables of tobacco users and nonusers enrolled in various courses were compared using chi-square test and two-way ANOVA. Furthermore, for each course, factors influencing tobacco use were identified using multivariable logistic regression analysis.

Results

The mean age of the sample was 19.5 ± 1.9 years, with the majority being female (65.3%). Lifetime prevalence of tobacco use varied from 0.5% in nursing students, 4.2% in medical students, 8.2% in students of arts and science, 12.5% in engineering students, and 22.8% among other students (law/fisheries). Approximately two-thirds of all tobacco users across courses showed signs of nicotine dependence. Dependent users also showed variance with none in nursing, 2.6% among medicine, 1.6% among arts and science, 1.9% among engineering, and 6.3% among others. Male gender and alcohol use were consistently associated with tobacco use across courses, whereas other examined psychosocial correlates showed variance.

Conclusions

To conclude, it appears that among college students, course-level characteristics may influence risk of tobacco use. This has public health importance as it suggests that interventions need to be tailored bearing this in mind. Future research needs to examine campus-level characteristics that may explain variance.

Predictors of Cigarette Smoking among Young Adults in Mangalore, India

BACKGROUND

The tobacco epidemic is a heralding health menace, particularly among college students. Tobacco usage among young can have an especially devastating effect as they can be exposed for longer periods. Data to estimate the prevalence of tobacco use in young adults will be a valuable addition to the existing resources.

MATERIALS AND METHODS

An analytical cross-sectional study was therefore carried out in Mangalore city using a pre-tested, self-administered questionnaire adapted from the Global Youth Tobacco Survey (GYTS) with a representative sample of 720 students aged 18-20 years selected from degree colleges by multi-stage random sampling.

RESULTS

Prevalence of 'ever users' and 'current users' of smoking were 20.4% and 11.4%, respectively. The mean age at initiation of cigarette smoking was 16 years and the majority (31 %) smoked in public places. Interestingly, 84% of them knew about the harmful effects of cigarette smoking. About one half of smokers had some or most of their friends smoking. Multivariate analysis revealed gender (OR=8.585: CI-3.26-22.5), pocket money (OR=4.165; CI=1.76-9.82) and peer's smoking habit (OR= 5.15; CI-2.21-11.9) have higher odds as correlates of tobacco usage among college students.

CONCLUSIONS

It is of prime importance to highlight the role of prevention of smoking initiation rather than subsequently trying to stop the habit. Comprehensive interventions embracing family, friends and social milieu are needed to reduce tobacco use among students in India.

Assessment of nicotine dependence among smokers in a selected rural population in Kerala, India

OBJECTIVES

An attempt was made to understand the nicotine dependence of smokers selected for an ongoing smoking cessation intervention programme in rural Kerala, India.

METHODS

Data were collected from resident males in the age group of 18 to 60 years from 4 randomly allocated community development blocks of rural Thiruvananthapuram district (2 intervention and 2 control groups). Trained accredited social health activist workers were utilised to collect data from all groups through face to face interview. Nicotine dependence among participants was assessed by means of the six-item Fagerstrom Test for Nicotine Dependence (FTND) translated into the local language. The internal consistency of FTND was computed using Cronbach's alpha coefficient. Criterion validity (concurrent) was assessed by correlations of nicotine dependence scores with age at initiation of smoking and cumulative smoking volume in pack-years.

RESULTS

Among the 928 smokers identified, 474 subjects were in the intervention area (mean age =44.6 years, SD =9.66 years) and 454 in the control area (mean age= 44.5 years, SD =10.30 years). The overall FTND score among current daily smokers was 5.04 (SD: 5.05). FTND scores in the control and intervention areas were 4.75 (SD: 2.57) and 4.92 (SD: 2.51) respectively. The FTND scores increased with age and decreased with higher literacy and socioeconomic status. The average FTND score was high among smokers using both bidi and cigarettes (mean 6.10, SD 2.17). Internal consistency analysis yielded a Cronbach's alpha coefficient of 0.70 in a subsample of 150 subjects, a moderate result. The association of the scale was strongest, with the number of pack-years smoked (rho = 0.677, p < 0.001).

CONCLUSION

A moderate level of nicotine dependence was observed among smokers in the current study. Tobacco cessation strategies could be made more cost effective and productive if a baseline assessment of nicotine dependence is completed before any intervention.

Patterns of Tobacco Consumption among Indian Men with Schizophrenia Compared to Their Male Siblings

OBJECTIVE

Tobacco consumption among patients with schizophrenia has been investigated extensively in western countries, but there is a dearth of studies in India, where socio-economic and cultural variables are different. This study aims to investigate the patterns of tobacco consumption among schizophrenia patients compared with their non-psychotic siblings.

METHODS

Consenting, successive male outpatients diagnosed with schizophrenia (n=100, DSM-IV criteria), and their non-psychotic brothers (n=100) were compared. Following a structured diagnostic interview, detailed information about tobacco consumption (including smokeless tobacco) was obtained using the Fagerstrom Test for Nicotine Dependence for smoked tobacco, and FTND-smokeless tobacco. The University of Pennsylvania Computerized Neurocognitive battery (CNB) was administered to a sub-group of patients (n=48).

RESULTS

Schizophrenia patients initiated tobacco use at a significantly earlier age than their brothers, but there was no significant difference with regard to type, quantity or frequency of tobacco use (smoke or smokeless varieties). Patients who consumed tobacco had significantly higher positive symptom scores compared with non-users (p=0.043). There were no significant differences between nicotine dependent and non-dependent patients with regard to CNB domains except attention.

CONCLUSION

Patterns of tobacco consumption were similar among schizophrenia patients and their non-psychotic brothers. Tobacco use was associated with increased positive symptom scores, but there were no significant differences in cognitive measures among nicotine dependent and non-dependent patients.