Risk factors associated with tobacco habits among adolescents: A cross-sectional school-based study

Background. The increase in tobacco use among adolescents in India is fraught with serious public health implications. The knowledge of factors which influence this habit could assist in tackling this problem. Hence, we aimed to determine factors associated with tobacco use among school students. Methods. Data on determinants of tobacco use were collected from 4786 students of classes VII to XII (age 11-19 years) studying in the schools of Noida city, using a self-administered questionnaire. A cluster sample design was used to produce a representative sample of schools. The classes were randomly selected and from each selected class, all students of every alternate section were included. Differences in proportions between the various groups were tested using Pearson chi-square test or Fisher exact test. Results. Of the 4786 students, 'current tobacco use' was reported by 197 (4.1%) students; 107 (2.2%) were exclusive smokers, 49 (1%) were exclusive tobacco chewers and 41 (0.9%) used both forms of tobacco. Tobacco use was less frequent among children of white collar than blue collar fathers (p < 0.05) and also among children of more educated than less educated mothers (p < 0.05). Tobacco use of father, mother, siblings and friends had a significant association with the student's tobacco use. The habits were 10.6-, 6.4-, 3.1-fold higher among students if they bought tobacco for teachers, brothers, father/relatives, respectively. Among tobacco users, 31.5% adopted these habits to refresh themselves, 45.9% preferred smoking outside home and 61% were influenced by actors smoking in films. Conclusions. Socioeconomic status, family and peer influence play an important role in students using tobacco.