Has the attitude of school students toward smoking changed after a decade since the framework convention of tobacco control?

Abstract

Sir, Nearly 6 million people die globally due to tobacco use and more than 63% of all deaths due to non-communicable diseases (NCDs) are related to tobacco use.[1] The WHO Framework Convention on Tobacco Control (WHO FCTC) is an international treaty adopted by the World Health Assembly on 21 May 2003. The WHO FCTC was developed in response to the globalization of the tobacco epidemic.[2] WHO introduced the MPOWER measures which are intended to assist in the country-level implementation of effective interventions to reduce the demand for tobacco, contained in the WHO FCTC.[3] India is one the signatories of the WHO FCTC and also has introduced many of the intervention measures suggested by FCTC which include Cigarettes and Other Tobacco Products Act, 2003 (COTPA)[4] and National Tobacco Control Program.[5] We intended to study the perception and attitude of school students toward tobacco use after a decade of efforts against tobacco use. A cross-sectional study was done between January and March 2012 in one of the higher secondary schools of rural Puducherry. Five schools in rural area within a 20-km radius from JIPMER were approached and only one school consented to participate in the study. The school was a private, English medium school with over 1000 students. There were a total of 233 students belonging to 8th, 9th and 10th(age group 13-15 years as included in Global Youth Tobacco Surveys) class. We included all the students who were present on the day of survey (N = 200) in the school from these three classes. Informed consent from the Principal of the school and Institutional Ethics Committee clearance was obtained for the study. On the survey day, the students were made to assemble in a hall and the Global Youth Tobacco Survey Core questionnaire (GYTS core questionnaire) was distributed to them. As the school's medium of education was English, the questionnaire was provided in English. Confidentiality and anonymity of the data collected were assured. Adequate time was provided for completion of the questionnaire. Data were analysed using SPSS (Statistical package for Social Sciences) version 16. All proportions were reported as percentages. Of the 200 students, 183 returned complete data collection forms and hence only they were included for analysis. Girls constituted 58.5% (107) of the study population. It was found that current use of tobacco in any form was seen in 12.6% of the students (Boys: 23.7%; Girls: 4.7%). Current use of smokeless form of tobacco was found among 6.6% of the students (Boys: 11.8%; Girls: 2.8%). Just more than half of the students (53.6%) felt that cigarette smoking is definitely harmful to health (Boys: 56.6%; Girls: 51.4%). The rest were not too sure and said that it may probably be harmful or harmless. The proportion of students who felt that second hand smoke was definitely harmful was found to be only 41% (Boys: 38.2%; Girls: 43%). A higher proportion of girls (76.6%) said that they would not smoke a cigarette in the next 5 years when compared to boys (51.3%). Only a very small proportion (<10%) of the students felt that smoking would result in more friends or make a person more attractive or comfortable at social gatherings. However, at least one-fourth of the students felt that smoking status made no difference in the number of friends one would have or in the attractiveness of an individual [Table 1].Table 1: Attitude toward tobacco use among students of a school in rural PuducherryTherefore, 10 years after WHO FCTC, the prevalence of tobacco use is similar to the national average studied in 2006.[6] Even after a decade of interventions, a section of the students have still not grasped the harmful effects of tobacco use and have a neutral attitude toward smoking and smokers. Hence efforts toward tobacco control needs to be revisited. Thank You.