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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 9  |  Issue : 1  |  Page : 44-47  

Prevalence of exposure to secondhand smoke among higher secondary school students in Ernakulam District, Kerala, Southern India


Department of Community Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

Date of Web Publication15-May-2017

Correspondence Address:
P S Rakesh
Department of Community Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-7406.206220

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   Abstract 

Introduction: The association between secondhand smoke and health outcomes, such as frequent respiratory infections, ischemic heart disease, lung cancer, asthma, and stroke, has long been established. The study aimed to estimate the prevalence of secondhand smoking exposure among higher secondary school students in Ernakulam district, Kerala, Southern India. Materials and Methods: Astructured questionnaire was administered to all students from four randomly selected higher secondary schools in Ernakulam district. Descriptive statistics was done using frequencies and percentages. Univariate and multivariate analyses were done for factors associated with household exposure to tobacco smoke generating odds ratios(ORs) and 95% confidence intervals(CIs). Results: Atotal of 629 students participated in the study. The prevalence of ever smokers was 11.9% and of current smokers was 5.2%. Among the study participants, 23.2% were exposed to secondhand smoking from a family member and 18.8% from friends. Lower educational status of father was associated with the household exposure to secondhand smoke(adjusted OR 4.51[95% CI 1.66–12.22]). More than half of the study participants(56.3%) reported that they were exposed to cigarette smoke in past 1week in a public place and 10.2% in closed public places. Nearly one-third of the students reported that they have seen somebody smoking inside school campus in the past 30days. Conclusion: Exposure to secondhand smoke at home, schools, and public places was higher among the late adolescent higher secondary school students in Ernakulam district. The findings underscore the urgent need for increased efforts to implement the strategies to reduce secondhand smoke exposure among adolescents.

Keywords: Adolescents, passive smoking, secondhand smoking, smoke-free environment


How to cite this article:
Rakesh P S, Lalu JS, Leelamoni K. Prevalence of exposure to secondhand smoke among higher secondary school students in Ernakulam District, Kerala, Southern India. J Pharm Bioall Sci 2017;9:44-7

How to cite this URL:
Rakesh P S, Lalu JS, Leelamoni K. Prevalence of exposure to secondhand smoke among higher secondary school students in Ernakulam District, Kerala, Southern India. J Pharm Bioall Sci [serial online] 2017 [cited 2019 Nov 14];9:44-7. Available from: http://www.jpbsonline.org/text.asp?2017/9/1/44/206220


   Introduction Top


Nearly one-third of all the world population is regularly exposed to secondhand smoking. This exposure is responsible for about 1% of the global burden of diseases in the form of respiratory infections, ischemic heart diseases, lung cancer, and asthma and is causing around 600,000 premature deaths globally.[1],[2] The association between secondhand smoke and health outcomes, such as frequent respiratory infections, ischemic heart disease, lung cancer, asthma, and stroke, has long been established. Nonsmokers who are exposed to secondhand smoke have an increased risk of developing heart disease at least by 25%, stroke by 20%, and lung cancer by 20%.[3],[4],[5]

The Government of India has become increasingly engaged with the country's tobacco problem over recent years.[6],[7] The more comprehensive Cigarette and Other Tobacco Products Act(addressing tobacco use in public places, tobacco advertising, and sale and packaging regulations) was introduced in 2003, and the Framework Convention on Tobacco Control brought into force in 2005.[8] In 2008, Government of India adopted legislations for banning smoking in public places.[9] With these interventions, the proportion of children and adolescents exposed to secondhand smoke is expected to come down.

The prevalence of smoking and exposure to secondhand smoking in India was varied based on the region. We conducted a study among higher secondary school children in Ernakulam district, Kerala, Southern India, to estimate the prevalence of chronic respiratory diseases and to study in detail the factors associated with it. The current paper analyzed the prevalence of secondhand smoking exposure among the study subjects. Findings from this study may help policymakers and program managers to know the effects of recent tobacco control interventions and to plan further strategies.


   Materials and Methods Top


Ernakulam district is the industrial capital of Kerala state situated on the coast of the Arabian Sea, with a population of 3.2 million. Adolescents constitute 15% of the population. More than 50% of the populations reside in urban areas. Primary school enrollment rate was nearly 100%.

Multistage random sampling was done. The list of all 42 higher secondary schools was obtained and stratified as urban and rural schools. Two schools each from urban and rural was randomly chosen, and all children in higher secondary division of the selected schools were included in the study.

Data collection was done during May 2016. Astructured questionnaire with 35 questions was prepared based on literature review, expert opinion, and group consensus. It included sociodemographic characteristics, details of respiratory symptoms, details of active and passive smoking, and indoor air pollution. Section on active and passive smoking was adapted from the Global Youth Tobacco Survey(GYTS) questionnaire.[10] The questionnaire was translated to regional language and back-translated to check for consistency. It was pilot tested before use. The unlinked anonymous questionnaire was administered in groups. Each question was read out by one of the investigators in regional language and doubts clarified. Purpose of the study was explained and confidentiality was ensured. Permissions were obtained from the head of the educational institutions, and informed consent was taken from the study participants. Participation in the study was voluntary. Data were entered and analyzed usingStatistical Package for Social Sciences (SPSS Inc. Released 2005. SPSS for Windows, Version 15.0. Chicago, SPSS Inc.). Descriptive statistics was done using frequencies and percentages. Univariate and multivariate analyses were done for factors associated with household exposure to tobacco smoke generating odds ratios(ORs) and 95% confidence intervals(CIs).


   Results Top


A total of 629 students participated in this study. Among them, 56.1% were males. Of them, 54.8% were residing at a rural location. Among the study participants, 93.9% of them lived in pucca houses(strong houses made of bricks and cement). The sociodemographic characteristics of the participants are shown in [Table1].
Table 1: Sociodemographic characteristics of the study participants (n=629)

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Among the study participants, 11.9%(75/629) reported that they ever smoked a cigarette in their lifetime and 5.1%(32/629) reported that they were current smokers. In the study, 23.2%(146/629) agreed that their family member used to smoke inside the house in their presence. Among them, 9.2%(58/629) said that they were inhaling the smoke from a family member for more than 10years. Majority(82.2%) of the respondents were exposed to smoke exhaled from father(120/146).

In the study, 18.8%(118/629) of the students revealed that they used to inhale smoke from a friend's cigarette. Among them, 56.3%(354/629) reported that they were exposed to cigarette smoke in past 1week in a public place and 10.2%(64/629) in closed public places. 34.7%(218/629) reported that they have seen somebody smoking inside school campus in the past 30days. The details of exposure to secondhand smoke among the study participants are shown in [Table2].
Table 2: Details of exposure to secondhand smoke (n=629)

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On analysis of factors associated with household exposure to tobacco smoke, low educational status of father was significantly associated with the exposure in both univariate and multivariate analyses(adjusted OR 4.51(95% CI 1.66–12.22]). There was no statistically significant difference noticed between passive smoking exposure at home and type of residence, place of residence or maternal education status. The details of univariate and multivariate analyses are shown in [Table3].
Table 3: Factors associated with being exposed to secondhand smoke at house

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   Discussion Top


The current study analyzed the secondhand smoking exposure among higher secondary school students in Ernakulam district. The prevalence of adolescents ever smoked a cigarette in the current study was consistent with results from GYTS, which showed the prevalence of ever smokers to be around 10% in the age group of 13–15years in India.[10] A very recent study among school students in Ernakulam revealed the prevalence of current smokers as 4.3%.[11] GYTS done in 132 countries reports that around half of all the students in the world were exposed to tobacco smoke inside and outside the home.[12] As per the WHO Report on Tobacco Epidemic 2009, about 34% of children in the age group of 13–15years were exposed to secondhand smoke at home in the Southeast Asian region.[1] In a study done among school children in Mumbai, 16.5% of students were exposed to secondhand smoke at home and 39.9% of students were exposed to secondhand smoke outside their homes.[13] The figure was 42% for adults in Kerala state.

WHO Framework Convention on Tobacco Control held at Paris concluded that 100% smoke-free environments are the only way to effectively protect people's health from the ill effects of secondhand tobacco smoke.[14] The current study reveals a high proportion of late adolescents exposed to passive smoking at homes, schools, and public places.

Cigarettes and Other Tobacco Products Act, 2003 in India has prohibited selling tobacco products to minors in Section 6 of the act. Furthermore, Section 6(b) prohibits sale of tobacco products within a radius of 100 yards of any educational institution.[9] Because of a favorable political commitment and an active engagement of various agencies in the state, many initiatives were held to make schools tobacco-free. The Government of Kerala has also incorporated tobacco control in its noncommunicable disease control program. State government kept on increasing the value added tax on cigarettes every year.[15]

The current study points out that despite these efforts and in spite of its high literacy and better health-care systems, tobacco problem still exists in the community. The study results point to the inadequate enforcement of banning of smoking in the public places in the state. The findings also lead to the speculation that illegal sale of tobacco products near educational institutions and to minors is happening in the state.

The study was conducted in one district of the state of Kerala and therefore cannot be generalized. The study relied on self-reporting by the subjects, and hence, both underreporting and overreporting might be possible. The study was primarily not intended to study tobacco use. Despite these limitations, the study has many public health implications.


   Conclusion Top


Exposure to secondhand smoke at home, schools, and public places was higher among the late adolescent higher secondary school students in Ernakulam district, Kerala. Reducing exposure to secondhand smoke among school children requires interventions to decrease tobacco use initiation, to promote tobacco cessation, and to control smoking in public places. The findings underscore the urgent need for increased efforts to implement the strategies to reduce secondhand smoke exposure among adolescents, to make homes, schools, and environment smoke-free, and thereby to prevent its harmful health effects.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
WHO Report on the Global Tobacco Epidemic 2009: Implementing Smoke-Free Environments. Geneva: World Health Organization; 2009. Available from:http://www.who.int/tobacco/mpower/2009/en/.[Last accessed on 2016 Aug 09].  Back to cited text no. 1
    
2.
World Health Organization. Global Health Observatory Data. Second Hand Smoke. Available from: http://www.who.int/gho/phe/secondhand_smoke/en/.[Last accessed on 2016 Oct 20].  Back to cited text no. 2
    
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Oberg M, Jaakkola MS, Woodward A, Peruga A, Prüss-Ustün A. Worldwide burden of disease from exposure to second-hand smoke: A retrospective analysis of data from 192 countries. Lancet 2011;377:139-46.  Back to cited text no. 3
    
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U.S. Department of Health and Human Services. Let's Make the Next Generation Tobacco-Free: Your Guide to the 50th Anniversary Surgeon General's Report on Smoking and Health. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014. Available from: Available from: https://www.surgeongeneral.gov/library/reports/50-years-of-progress/consumer-guide.pdf. [Last accessed on 2016 Oct 05].  Back to cited text no. 4
    
5.
U.S. Department of Health and Human Services. The Health Consequences of Smoking-50Years of Progress: AReport of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014. Available from: https://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf. [Last accessed on 2016 Aug 20].  Back to cited text no. 5
    
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Kaur J, Jain DC. Tobacco control policies in India: Implementation and challenges. Indian J Public Health 2011;55:220-7.  Back to cited text no. 6
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7.
McKay AJ, Patel RK, Majeed A. Strategies for tobacco control in India: A systematic review. PLoS One 2015;10:e0122610.  Back to cited text no. 7
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8.
Ministry of Law and Justice. The Cigarettes and Other Tobacco Products(Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act; 2003. Available from: http://www.who.int/fctc/reporting/Annexthreeindia.pdf. [Last accessed on 2016 Aug 21].  Back to cited text no. 8
    
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The Gazette of India. No 304. Part II. Sec 3. Sub Sec(i). NewDelhi; 30 May, 2008. Available from: http://www.karhfw.gov.in/PDF/GazofIndia%20-%20part%20II%20-%20Sec%203%20-%20sub%20sec%20(i).pdf.[Last accessed on 2016 Sep 20].  Back to cited text no. 9
    
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Gajalakshmi V, Kanimozhi CV. Asurvey of 24000 studentsaged13-15years in India: Global youth tobacco survey 2006 and 2009. Tob Use Insight 2010;3:23-31.  Back to cited text no. 10
    
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Jayakrishnan R, Geetha S, Mohanan Nair JK, Thomas G, Sebastian P. Tobacco and alcohol use and the impact of school based antitobacco education for knowledge enhancement among adolescent students of Rural Kerala, India. JAddict 2016;2016:9570517.  Back to cited text no. 11
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GTSS Collaborative Group. Across country comparison of exposure to secondhand smoke among youth. Tob Control 2006;15Suppl2:ii4-19.  Back to cited text no. 12
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Raute LJ, Pednekar MS, Mistry R, Gupta PC, Pimple SA, Shastri SS. Determinants of exposure to second-hand smoke at home and outside the home among students aged 11-17years: Results from the Mumbai Student Tobacco Survey 2010. Indian J Cancer 2012;49:419-24.  Back to cited text no. 13
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WHO. Report to Parties on Framework Convention on Tobacco Control. Second Session. First Report of Committee A. Geneva, Switzerland: WHO; 2007. Available from: http://www.apps.who.int/gb/fctc/E/E_it2.htm.[Last accessed on 2016 Aug 22].  Back to cited text no. 14
    
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Office of the Commissioner of Commercial Taxes, Circular No. 09/2015, Salient Features of Kerala Finance Bill; 2015. Available from: http://www.keralataxes.gov.in/circular/CIR.9.15.pdf. [Last accessed on 2016 Sep 20].  Back to cited text no. 15
    



 
 
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