Pattern of Tobacco Use Among Higher Secondary Children in the Rural and Coastal Areas of Kerala: A Prospective Study

Abstract

India is the second largest consumerof tobacco products after China and its consumption is a serious social issue most developing countries. The current study was undertaken to assess the prevalence of use of tobacco and its products among higher secondary school children in the costal and rural areas of Kerala, the state having highest literacy rate in the country. Tobacco consumption is an important cause of mortality and morbidity in India. The study was conducted in the higher secondary schools along the rural and coastal areas of Karungappally Taluk in the Kollam district of Kerala from October to December of 2017, 15 government and aided schools were selected. The data were collected with the help of a questionnaire. A total of 5678 students participated in the study. The purpose of the study was explained to the students with participation of National Service Scheme volunteers who distributed the data sheets to the students and helped in data collection. The school visit was coupled with lecture on the adverse effects of tobacco on health with pictures of cancers of the oral cavity, surgery and reconstruction. The collected data were entered into Microsoft Excel datasheet and analyzed with SPSS 17.0 software. The Departments of Surgical Oncology, Regional Cancer Centre and Directorate of Higher Secondary School participated in the study. 5678 students participated in the study, that include 2567 boys and 3111 girls. 760 out of 2567 boys use tobacco, 308 out of 760 (40%) use more than 1 type of tobacco products. Cigarettes and pan masala are the popular forms of tobacco among the students. 253 boys out of 760 (33%) had used alcohol as well. 1819 students said their close relatives use tobacco and its products at home. 1420 said their close relatives consume alcohol. Bricker et al. says that, siblings, parents and close friends' smoking were all important influences on children's smoking (5). 94.7% (5382) of students are aware of the ill effects of tobacco, they are aware that tobacco consumption can lead to cancer of the lung, oral cavity, stroke and heart attack. 479 students said they are aware that the diseased part of oral cavity have to be removed by surgery. Students were also familiar with terms such as chemotherapy and radiotherapy, however it is doubtful whether they are aware of the complications associated these modes of treatment. 4578 (81%) students showed interest in antitobacco activities. 2347 students said the tobacco products are available in school premises and 1064 said they are available within the campus itself. 40% started tobacco smoking for fun, but 28% started mimicking the elders and 20% wanted to be the heroes in the campus. A recent study by Sargent et al also found a strong association between exposure to movie smoking and smoking by adolescents (4). In our study none of the girls were using tobacco.