Prevalence of Exposure to Secondhand Smoke among Higher Secondary School Students in Ernakulam District, Kerala, Southern India

Second Hand Smoke Exposure among Children in Indian Homes: Findings from the Global Adult Tobacco Survey

Children are vulnerable to second hand smoke (SHS) exposure because of limited control over their indoor environment, especially at homes. This study determines the magnitude, patterns and determinants of SHS exposure in the home among children in India. Data collected under the Global Adult Tobacco Survey (GATS) data, a household survey of adults ≥15 years of age during 2016-2017 conducted in India were analyzed to estimate the proportion of children exposed to SHS in their homes. GATS estimates and national census population projections for 2020 were also used to estimate the number of children exposed to SHS in the homes. Nearly half (46.5%) of the children <15 years of age were exposed to SHS in their homes in India which extrapolates to nearly an estimated 170 million. Children living in rural households, north-east and central regions and households with an adult smoker were more likely to be exposed to SHS. SHS exposure among children in home is high in India which calls for adoption of voluntary smoke-free homes initiative and promoting cessation among smokers.

Tobacco use and exposure to second-hand smoke among high school students in Ernakulum district, Kerala: A cross-sectional study

Objectives

Tobacco use and exposure to second-hand smoke (SHS) in the home setting are major health hazards for adolescents. The objectives of this study were to estimate tobacco use and exposure to SHS among high school students in Ernakulam district of Kerala, India, and to investigate associated factors.

Study design

Cross-sectional study.

Methods

A school-based cross-sectional study was carried out in 25 randomly selected high schools from 210 schools in the Ernakulam educational district of Kerala, India. The minimum calculated sample size for ever-use of tobacco and SHS exposure was determined to be 2500, with 95% confidence interval (CI) and 10% relative precision. Data were collected using a semi-structured, pre-tested questionnaire from 2585 high school students. Data analyses were performed using SPSS version 20.

Results

The ever-use of tobacco was reported to be 3.9% (95% CI 3.16 to 4.54) and the mean age of the participants was 13.97 ± 0.77 years. One-fifth of participants had tried a tobacco product before the age of 10 years. SHS exposure at home was reported by one in every 5 respondents (20.3%). Male gender (adjusted odds ratio [aOR] 8.79; 95% CI 3.16, 24.53), presence of a family member who smokes within the home (aOR 4.28; 95% CI 2.58, 7.12), lack of awareness about the harmful effects of SHS exposure (aOR 2.47; 95% CI 1.41, 5.18) and having seen an advertisement or promotion at point of sale (aOR 2.16; 95% CI 1.29, 3.60) were found to be independent predictors for tobacco use.Participants with respiratory infections were three times more likely to have experienced SHS exposure at home (aOR 2.87; 95% CI 2.21, 3.74), there was an 86% protective effect of SHS exposure for participants with a father in a professional occupation compared with unskilled profession (aOR 0.14; 95% CI 0.02, 0.67; p < 0.15) and participants with ever-use of tobacco were two times more likely to have experienced SHS exposure at home (aOR 1.63; 95% CI 3.13, 8.98).

Conclusions

SHS exposure in the home environment continues to be high. Urgent innovative measures are necessary for the implementation of tobacco smoke-free homes and to reduce tobacco use in this vulnerable population. Further studies are necessary to determine ways to reduce smoking within homes and to increase population awareness.

Clustering of noncommunicable disease risk factors among adolescents attending higher secondary schools in Kasaragod District, Kerala, India [version 2; peer review: 1 approved with reservations]

Background

Limited evidence exists on the presence of collective non-communicable disease (NCD) risk factors among adolescents in Kerala, India. We aimed to assess the prevalence and factors associated with multiple NCD risk factors and the clustering of these risk factors among adolescents in Kasaragod District, Kerala.

Methods

We selected 470 adolescents (mean age 16.6 years, male 53.8%) through multi-stage cluster sampling from higher secondary schools of Kasaragod district. Self-administered questionnaires were used, and anthropometric measurements were taken using standard techniques and protocols. Tobacco use, alcohol consumption, low fruits and vegetable consumption, inadequate physical activity, extra salt intake, overweight, consumption of soft drinks and packed foods were the eight NCD risk factors included.The factors associated with one, two and three or more NCD risk factors were analysed using multinomial logistic regression and the standard errors were adjusted for the four clusters.

Results

Risk factor clusters with two risk factors (dyads) and three risk factors (triads) were observed in 163 (34.7%) and 102 (21.7%) of the sample, respectively. Adolescents residing in urban areas (odds ratio (OR) = 3.55; 95% confidence interval (CI) = 1.45-8.73), whose father's education level was lower (OR = 3.54; 95% CI = 1.24-10.10), whose mother's education was lower (OR= 4.13; 95% CI = 1.27-13.51), who had restrictions on physical activity (OR = 5.41; 95% CI = 1.20-24.30) and who did not have a kitchen garden (an area where fruits and vegetables are grown for domestic use) (OR=4.51;95% CI = 1.44-14.12) were more likely to have three or more NCD risk factors compared to their counterparts.

Conclusions

Clustering of NCD risk factors was prevalent in more than half of the adolescents. Efforts are warranted to reduce multiple risk factors, focussing on children of low educated parents and urban residents.

Clustering of noncommunicable disease risk factors among adolescents attending higher secondary schools in Kasaragod District, Kerala, India

Background: Limited evidence exists on the presence of collective non-communicable disease (NCD) risk factors among adolescents in Kerala, India. We aimed to assess the prevalence and factors associated with multiple NCD risk factors and clustering of these risk factors among adolescents in Kasaragod District, Kerala. Methods: We selected 470 adolescents (mean age 16.6 years, male 53.8%) through multi-stage cluster sampling from higher secondary schools of Kasaragod district. Self-administered questionnaires were used, and anthropometric measurements were taken using standard techniques and protocols. Tobacco use, alcohol consumption, low fruits and vegetable consumption, inadequate physical activity, extra salt intake, overweight, consumption of soft drinks and packed foods were the eight NCD risk factors included. Multinomial logistic regression analysis was done to find out the factors associated with one, two and three or more NCD risk factors. Results: Risk factor clusters with two risk factors (dyads) and three risk factors (triads) were observed in 163 (34.7%) and 102 (21.7%) of the sample, respectively. Adolescents residing in urban areas (odds ratio (OR) = 3.55; 95% confidence interval (CI) = 1.45-8.73), whose father’s education level was lower (OR = 3.54;  95% CI = 1.24-10.10), whose mother’s education was lower (OR= 4.13; 95% CI = 1.27-13.51), who had restrictions on physical activity (OR = 5.41; 95% CI = 1.20-24.30) and who did not have a kitchen garden (an area where fruits and vegetables are grown for domestic use) (OR=4.51;95%  CI = 1.44-14.12) were more likely to have three or more NCD risk factors compared to their counterparts.   Conclusions: Clustering of NCD risk factors was prevalent in more than half of the adolescents. Efforts are warranted to reduce multiple risk factors, focussing on children of low educated parents and urban residents. Parents of adolescents may be encouraged to have kitchen gardens and not to restrict adolescent’s physical activity.

Exposure to Second Hand Tobacco Smoke among 12 year old Adolescents in Mangalore, Karnataka - A Descriptive Study

Background:

There is no safe level of exposure to second hand tobacco smoke (SHS). The World Health Organization has stressed that 100% smoke-free environments are the only effective way to protect the population from the harmful effects of exposure to SHS.

Methods:

A descriptive cross-sectional questionnaire study was done on 1442, 12 year old, adolescents in Mangalore to determine the exposure to SHS and adolescents’ knowledge, attitude, avoidance and self-efficacy of avoidance towards SHS.

Results:

The percentage of children exposed to SHS at home was 28.6%. A higher number of male students reported that their parent and/or sibling smoked tobacco compared to their female counterparts. About 48% of the participants reported that persons who lived with them smoked in front of children and this was found to be significantly higher among males compared to females. Atleast 46% of the participants had knowledge of second hand tobacco smoke. The avoidance behaviour of the participants was good with most of the participants reporting positive avoidance towards SHS. With respect to their self - efficacy of avoidance of SHS, most of them were confident of avoiding SHS when they were with family or friends but the confidence was less with respect to strangers. Multivariate general linear model analysis showed a significant association between gender and exposure to SHS to 14 items out of the 25 items in the four domains. Males and those not exposed to SHS showed better knowledge, positive attitude, positive avoidance behaviour and positive self efficacy of avoidance to SHS.

Conclusion:

The findings of our study indicate that better knowledge and a positive attitude and avoidance behavior are associated with reduced exposure to SHS and this reinforces the fact that a sustained health education program incorporated into the school curriculum is the need of the hour.

Second-hand smoke exposure and its determinants among nonsmoking adolescents residing in slum areas of Bhubaneswar, India

Background

Second-hand exposure (SHS) is a significant public health problem and accounts for over 600,000 deaths among non smokers worldwide every year. The study aimed to estimate the prevalence and determinants of SHS exposure among nonsmoking adolescents residing in slum areas of Bhubaneswar, India.

Methods

Multistage cluster random sampling was used to select 259 nonsmoking adolescents from eleven slum areas. We used descriptive statistics to determine the prevalence of SHS exposure and inferential statistics using multivariable logistic regression model to identify factors associated with SHS exposure.

Results

Of the 259 adolescent participants, 67 (25.9%) were exposed to SHS inside home and 97 (37.5%) were exposed outside home. About 47.5% adolescents were exposed to anti-smoking media messages and 22.8% were unaware of the harmful effects of exposure to SHS. SHS exposure inside home was associated with smokeless tobacco use (adjusted odds ratio [aOR]: 10.64; 95% confidence interval (CI): 2.57-43.48), illiteracy of father (aOR: 5.40; 95% CI: 1.51-19.32), non-exposure to antismoking media messages (aOR: 3.53; 95% CI: 1.06-11.72), and absence of knowledge regarding harmful effects of SHS (aOR: 3.72; 95% CI: 1.15-12.05). Also, variables like male gender (aOR: 10.31; 95% CI: 4.50-23.81), smokeless tobacco use (aOR: 2.43; 95% CI: 1.05-5.65), illiteracy of father (aOR: 4.58; 95% CI: 1.23-17.14), and non-exposure to antismoking media messages (aOR: 4.04; 95% CI: 1.49-10.89) had increased SHS exposure outside home.

Conclusion

The findings underscore the urgent need to implement comprehensive smoke-free policies to reduce SHS exposure among slum adolescents.

Factors Affecting Secondhand Smoke Avoidance Behavior of Vietnamese Adolescents

The purpose of this study was to examine the stage of secondhand smoke avoidance behavior of adolescents in rural areas of Vietnam and the related factors affecting such behavior. The participants were recruited from two middle schools located in Hai Thuong and Trieu Trach commune, Vietnam. Data were collected in January 2016 by distributing and collecting a self-administrated questionnaire. The collected data were analyzed (n = 166) using SPSS 21.0 for frequency, percentage, and ordinal logistic regression. The largest proportion of secondhand smoke avoidance behavior was classified in maintenance (41.6%), followed by action (19.9%), preparation (15.1%), pre-contemplation (13.3%), and contemplation (10.2%) stages. The factors related to higher secondhand smoke avoidance behavior were higher self-efficacy (p = 0.003) and more frequent discussion with parents about dangers of smoking (p = 0.001). The findings indicated that self-efficacy of avoiding secondhand smoke and discussion with parents were associated with secondhand smoke avoidance behavior of adolescents. These findings can be used for developing education programs to prevent secondhand smoke for adolescents in Vietnam.