Prevalence of Tobacco Use Among Adolescents in India

PRESENTER: HEMANT GOLHARMODERATOR: DR. D. G. DAMBHARE Jayakumary Muttappallymyalil,

Binoo Divakaran, Teena Thomas, Jayadevan Sreedharan

Asian Pacific Journal of Cancer Prevention, Vol. 13, 2012 (5371-5374)

Learning objectives: -

To study the simple random sampling (sampling methods).

Objective :

(a) to assess prevalence of tobacco use among adolescents (b) to ascertain the reasons for initiating tobacco use

(c) to study the type of tobacco use among them.

INTRODUCTION:-

• Smoking is most likely to begin during adolescence.

• Many studies have reported that children smoke their first cigarette while attending primary school.

• It is observed that there is increase in smoking habit over the years.

• Smoking is more prevalent among males compared to females

• It is better to prevent the initiation of the habit than trying to stop the habit.

• A cross sectional study in Noida city reported an overall ever smoking prevalence of 8.8% and also observed no significant difference between the genders regarding the use of other tobacco items such as hokkah, pipe, cigars and ganja, which was more prevalent among males (Narain et al., 2011).

A study in United Arab Emirates reported that the smoking prevalence in adolescents was 14.3% among boys and 2.9% among girls (Abi et al., 2003).

A study among French adolescents showed the prevalence of smoking habit among males and females almost same, 15.4% and 15.8% respectively (Botelho et al., 2003).

In India, a study conducted in Bangalore reported a prevalence of 6.8% smoking among 13-15 years aged students (Shashidhar et al., 2011).

A 3% overall prevalence was reported in Punjab during a survey conducted by siziya et al and also it was noted that smoking was more prevalent among males compared to females (Siziya et al., 2008).

METHODS:-

It was a cross sectional study conducted among school children from ten randomly selected schools in Kannur district of Kerala state in India.

Children between the age groups 14 and 18 years, belonging to both genders were approached to participate in the study from randomly selected schools.

verbal consent was obtained from the participants before administering the questionnaire.

A total of 3,000 children from ten randomly selected schools participated in this cross-sectional study.

Data Collection:-

A self-administered, pre-tested, structured, close-ended questionnaire was used for data collection.

The questionnaire comprised information on socio-demographic characteristics such as age, gender, grade etc.

Tobacco consumption habit was assessed in detail such as type of tobacco used, mode of consumption, duration of tobacco use, reasons for use etc.

A pilot run was conducted before finalizing the questionnaire.

The study was conducted over a period of six months.

Data analyses:Data was entered into Excel spread sheet and analyzed using SPSS 17 for data management and analysis.

Students who were currently using any type of tobacco were included in the estimation of prevalence of tobacco users.

Type of tobacco use was compared with socio-demographic characteristics.

AGE IN YEARS BOYS (%) GIRLS (%) TOTAL

14 50 (3.9) 110 (6.4) 160

15 170 (36.4) 640 (37.4) 1110

16 370 (28.7) 580 (33.9) 950

17 310 (24.0) 360 (21.1) 670

18 90 (7.0) 20 (1.2) 110

TOTAL 1290 (43%) 1710 (57%) 3000

TABLE NO.1:-

Age and gender distribution of the participants

RESULTS:-

AGE IN YEARS TOBACCO HABIT (%) TOTAL

14 00 160

15 73 (6.58) 1110

16 57 (6.00) 950

17 27 (1.03) 670

18 9 (8.18) 110

TOTAL 160 (5.53) 3000

TABLE NO. 2- Prevalence Of Tobacco Habit According To Age

Out of 3000 participants, 160 were using tobacco products. The overall prevalence observed was 5.5%.

AGE IN YEARS TOBACCO HABIT TOTAL

14 00 50

15 73 (18.4) 397

16 57 (18.2) 313

17 27 (9.5) 283

18 9 (11.1) 81

TOTAL 166 (12.9) 1290

TABLE NO. 3:-Prevalence Of Tobacco Habit Among Boys

The overall prevalence among boys was 12.9%.

HABIT- FATHER HABIT-CHILD TOTAL

YES NO

YES 82 1118 1200

NO 84 1716 1800

TOTAL 166 2834 3000

TABLE NO.:- 4Habit Of Father Vs. Habit Of Children

Father’s tobacco habit is associated with the child’s tobacco habit.

HABIT-FRIEND HABITUEES TOTAL

YES NO

YES 55 75 130

NO 111 2759 2870

TOTAL 166 2834 3000

TABLE NO.:- 5Habit Of Friend Vs. Habituees

Of the total students with tobacco habit, 33.1% reported that their friends were also tobacco users.

REASONS FREQUENCY %

FOR FUN 28 16.8

INFLUENCE OF FRIENDS 66 39.8

DUE TO OTHERS (PARENTS, TEACHERS, RELATIVES etc.)

63 38.0

FOR INQUISITIVENESS 9 5.4

TOTAL 166 100.0

TABLE NO.:- 6Reasons For Starting The Habit

40% of the students started smoking because of compulsion from friends or to follow others whom they considered as role models followed by 16.8% for fun.

CONCLUSION:-

The study concluded that among adolescents, the tobacco habit usually starts with bidi smoking.

The over all prevalence observed was 5.53% and the habit was seen only among boys.

The peer group influence was the reason for initiating this habit in majority of the users. Also association between Father’s tobacco habit and the child’s tobacco habit was observed.

The present study suggests the need for school based tobacco prevention programs and it is better to prevent the initiation of the habit than trying to stop the habit, highlighting the role of primordial prevention.

COMMENTS:-

In study setting they have not mentioned whether the study was conducted in rural or urban area.

It is not mentioned how the sample size was calculated.

Outcome exposure variable are not clearly mentioned.

Limitations of the study are not mentioned.

Similar study:Article Author ConclusionPrevalence and correlates of tobacco use among urban adultmen in India: A comparison of slum dwellers vs non-slumdwellers

Rooban T, Elizabeth Joshua, Umadevi K Rao, Ranganathan K

Cigarette/bidi smoking was the commonest form of tobacco use among the study population. Pan masala use was the least common form of smokeless tobacco use, next only to snuff.Among slum males, the ‘poorest’ of were more likely to use tobacco, while ‘poorer’ males were more likely to use tobacco among non–slum dwellers.

Article Author ConclusionA cross-sectional study of the prevalence andcorrelates of tobacco Use in Chennai, Delhi,and Karachi

Berg et al. BMC Public Health (2015) 15:483

Overall, 51.8 % were females, and 61.6 % were below the age of 45 years. Lifetime (ever) tobacco useprevalence (standardized for world population) was 45.0 %, 41.3 %, and 42.5 % among males, and 7.6 %, 8.5 %,and 19.7 % among females in Chennai, Delhi, and Karachi, respectively.Past 6 month tobacco use prevalence(standardized for world population) was 38.6 %, 36.1 %, and 39.1 % among males, and 7.3 %, 7.1 %, and 18.6 %among females in Chennai, Delhi, and Karachi, respectively.

Article Author ConclusionTobacco use in India: prevalence and predictors of smokingand chewing in a national cross sectional household surveyTobacco Control 2003;12:e4

Rani, Bonu, Jha, et al

30% of the population 15 years or older—47% men and 14% of women—either smokedor chewed tobacco.11% and 1.5% Prevalence for chewingtobacco among men and women respectively.Tobacco consumption was significantly higher in poor, less educated, scheduled castes and scheduled tribe populations.

Article Author ConclusionTobacco consumption in relation to causesof death in an urban population of north India

Ram B SinghSurendra SinghPronobesh ChattopadhyaEt al.

The prevalence of tobacco consumption, including chewing + smoking, were 45%(n = 623) among men and 15% (n = 125) among women decedents. However, smoking wasobserved in 20% and tobacco chewing in 30% of male decedents, while only 6% of femaledecedents smoked and 10% chewed tobacco.

Article Author ConclusionTobacco consumption among adolescentsin rural Wardha: Where and how tobaccocontrol should focus its attention?

Dongre AR, Deshmukh PR, Murali N, Garg BS

About 68.3% boys and 12.4% girls had consumed any tobacco products in last 30 days. Out of boys who hadconsumed tobacco, 79.2% consumed kharra, and 46.4% consumed gutka. Among boys, 51.2% consumed it due to peerpressure, 35.2% consumed tobacco as they felt better, and fi ve percent consumed tobacco to ease abdominal complaintsand dental problem. Among girls, 72% used dry snuff for teeth cleaning, 32% and 20% consumed tobacco in the form ofgutka and tobacco & lime respectively.

References used in study:-

Abi saab BH (2003). Tobacco use among young people in UAE. Proceedings of the 12 th World Conference on Tobacco or Health, Helsinki. Botelho F, Lopes C, Barros H (2003). Smoking and depressive symptoms- A community survey. Proceedings of the 12th World Conference on Tobacco or Health, Helsinki. Chassin L, Presson C, Sherman SJ (1985). Psychosocial correlates of adolescent smokeless tobacco use. Addict Behav, 10, 431-5. General education department Government of Kerala. [cited on 2012 July 27th] Available at: http://www.education.kerala. gov.in/index.php?option=com_content&view=article&id= 141&Itemid=143. Joffe A, McNeely C, Colantuoni E, et al (2009). Evaluation of school-based smoking-cessation interventions for self-described adolescent smokers. Pediatrics, 124, 187-94. Kimberly AH, Xin G, Geri AD, Sachin Kamal-Bahl (2000). Determinants of youth tobacco use in West Virginia: a comparison of smoking and smokeless tobacco use. Am J drug Alcohol Abuse, 26, 125-38. Lovato CY, Zeisser C, Campbell S, et al (2010). Adolescent smoking: effect of school and community characteristics. Am J Prev Med, 39, 507-14.

Makwana NR, Shah VR, Yadav S (2007). A study on prevalence of smoking and tobacco chewing among adolescents in rural areas of Jamnagar District, Gujarat State. JMSR, 1, 47-50. Murnaghan DA, Leatherdale ST, Sihvonen M, Kekki P (2009). School-based tobacco-control programming and student smoking behaviour. Chronic Diseases in Canada, 29, 169-77. Narain R, Sardana S, Gupta S, Sehgal A (2011). Age at initiation and prevalence of tobacco use among school children in Noida, India: A cross-sectional questionnaire based survey. Indian J Med Res, 133, 300-7. Otte R, Engels RC, Prinstein MJ (2009). A Prospective Study of perception in adolescent smoking. J Adolescent Hlth, 44, 478-84. Patna, Gupta PC (2002). Youth tobacco Surveillance in Northeastern States of India, 2001; Proceeding of Tobacco Research in India: Supporting efforts to reduce harm. Shashidhar A, Harish J, Keshavamurthy SR (2012). Adolescent Smoking - A Study of Knowledge, Attitude and Practice in High School Childre, Pediatric on call child health care [serial online] 2011 [cited 2012 March 4], Available at: http:// www.pediatriconcall.com/fordoctor/Medical_original_ articles/smoking.asp. Siziya S, Muula AS, Rudatsikira E (2008). Correlates of current cigarette smoking among school-going adolescents in Punjab, India: results from the Global Youth Tobacco Survey 2003, BMC International Health and Human Rights, 8(1), [cited 2012 February 28] Available at: http://www.ncbi.nlm. nih.gov/pmc/articles/PMC2244596/pdf/1472-698X-8-1.pdf. Suryawanshi SL, Nimale NE (2001). A socio epidemiological survey of tobacco chewing habits in Aurangabad, Maharashtra State. Indian J Community Hlth, 7, 45-8.

Sampling methods• A sample must be selected in such a way that it is possible to

generalize from observations made on the sample to the characteristics of the study population.

• Sampling process• Defining the population• Developing a sample frame• Specifying sample method• Determining sample size and• Selecting the sample.

The following methods of sampling are in general use.

Simple random sampling:-

A sample may be defined as random if every individual in the population being sampled has an equal likelihood of being included.

Random selection is the basis of all good sampling techniques.

In order to select a simple random sample from a population it is first necessary to identify all individuals from whom the selection will be made.

The usual method of selecting a simple random sample from a listing of individuals is to assign a number to each individual and then select certain numbers by reference to random number table, which are published in books of statistical tables.

It is best among the Probability sampling methods.

Every Sampling unit has equal chance to get selected as a part of sample.

Probability of selection remain constant.

Kills most of the resources in preparation of Sampling Frame.

No guarantee of selecting same sample if attempted repeatedly.

Random Number table or computer assisted programs can be used for random no. generation.

Systematic sampling:

An alternative method of sampling is to take a systematic sample, in which every ‘n’th person is selected from a list or from some other ordering.

A systematic sample can be drawn from a queue of people, or from patients ordered according to the time of their attendance at a clinic, and thereby enables a sample to be drawn without an initial listing of all persons among whom the selection will be made.

In order to fulfil the statistical requirements for a random sample a systematic sample should be drawn from patients who are randomly ordered.

The starting point for selection should be randomly chosen.

If every third person on a register is being selected then a random procedure must be used to determine whether the first, second or third person on the register is chosen as the first member of the sample.

Clearly there are three possible samples: 1) patients 1,4,7…. 2) patients 2,5,8…. 3) patients 3,6,9…..

One advantage to this technique is its simplicity.

Multi stage sampling or cluster sampling:-

Cluster sampling is a technique used when “natural” groupings are evident in a population.

In this technique, the total population is divided into these groups (or clusters) and a sample of the groups is selected.

In a survey covering a district, state or country an initial sample may be taken from units of the population such as villages.

The villages are listed and a random sample of the required number selected.

Then the listing of individuals within the chosen villages is made and a sample taken from them.

This method of sampling has the advantage that a listing of persons is only required for the relatively small unit from which the final selection is made.

Cluster sampling of a population is liable to cause errors if the disease, attribute or variable being studied is itself clustered in the population.

The technique works best when most of the variation in the population is within the groups, not between them.

It is also known by 30x7 or 30x10

Emphasizes on identification of 30 locations called as “Cluster”.

From each cluster select desired no. of sample unit by employing any of the probability sampling method.

Stratified sampling:-

If a disease is unevenly distributed within a population in respect of sex, age, or some other attribute or variable it may be better to choose a stratified sample.

To obtain a sample stratified by age, for example the study population is sub-divided into age groups, such as 0-14 years, 15-49, and 50 & above.

A different fraction of each group is then selected as the sample, either by simple random sampling or systematic sampling.

Common Stratifying Characteristic are

Place of Residence : Urban / RuralSex : Male / FemaleIncome : Low / Middle / HighDistance, Religion, Caste etc.

Stratified Random Sampling assures that, you will be able to represent not only the overall population, but also key subgroups of the population, especially small minority groups.

Second, stratified random sampling will generally have more statistical precision than simple random sampling. This will only be true if the groups are homogeneous, or consistent within each group.

Non Probability Sample

• Judgment/Purposive Sample.

• Convenient Sample.

• Quota Sample.

• Snowball Sampling.

Used if..• Conducting Qualitative, Pilot or exploratory

Study.

• When Randomization is not possible.

• Not aimed to generalize the result.

• Wish to demonstrate the existence of particular trait in the population .

• Judgmental Sampling- Units with a specific purpose in mind.- Researcher believes that some units are more suitable as compared

to others.

• Convenience Sampling• Most commonly used sampling.• Units are chosen simply because of they are easy to recruit.• Easiest, cheapest and least time consuming.

• Quota Sampling

• More or less similar to stratified sampling.

• Only basic difference – at strata level the units are selected

randomly.

• The bases for quota are usually age, gender, education, religion

etc.

Snowball Sampling

Thanks