ABSTRACT
Aim:
To understand the psychodynamics of tobacco use among 11- to 14-year-olds in Ahmedabad, India.
Materials and Methods:
A self-administered questionnaire was used to gather information on tobacco use from 5,266 students, aged 11 to 14, enrolled in government-aided English medium schools in Ahmedabad. IBM® SPSS® 26.0 software along with Chi-square tests were used to analyze the data.
Results:
A total of 7.2% (376) had ever used tobacco. Of the users, 96.6% (363) knew it was harmful, 76.3% (287) were boys, and 85.2% (320) were initiated by family and friends.
Conclusion:
Despite being aware of the dangers of tobacco and being unable to purchase from vendors, children continued to obtain tobacco products, being influenced by their close social networks. An effective cessation measure should be directed toward this psychodynamic etiology.
KEYWORDS: Abuse, addiction, adolescent, children, tobacco
INTRODUCTION
Tobacco consumption poses a major challenge to world health and society. When this habit is initiated in childhood or adolescence, it worsens in adulthood, contributing to 90% of premature deaths among tobacco users.[1] The earlier such habits start, the faster the onset of detrimental effects.
The Global Youth Tobacco Survey (GYTS) 2019 for India reveals that the prevalence of current use of tobacco among 13- to 15-year-olds is 8.5%.[2] A study in Gujarat state, India, showed a downward shift in the age of initiation of this habit.[3] While the reasons for tobacco consumption in children are poorly probed into, the ill effects of this habit are extensively documented.[4]
Dental professionals are in a unique position to identify tobacco users earlier than other healthcare providers through intraoral signs and symptoms. They can provide preventive and interventional care through tobacco cessation protocols involving pharmaceutical and nonpharmaceutical measures such as Nicotine Replacement Therapy (NRT) and Cognitive Behaviour Therapy (CBT), respectively.[5,6]
In India, tobacco-related mortality is about 1.35 million annually.[7] Tobacco use flourishes intensively despite substantial knowledge of its harmful consequences, which involve morbid hospitalization and death. Hence, it is pertinent to comprehend the factors inspiring its use to plan effective interventions directed at the community level. The aim of the present study was to understand the psychodynamics of tobacco usage among children.
MATERIALS AND METHODS
A convenience sample of 5,266 children between the ages of 11 and 14 from randomly selected 18 government-aided English medium schools in Ahmedabad, India were chosen based on equal probability sampling to participate in a cross-sectional questionnaire survey. On the day of the study, only those who were present and whose parents granted them their consent to be included in this research made up the sample. Mentally compromised children were excluded.
A standardized and validated self-administered questionnaire to gather information about tobacco use. The questionnaire included questions about awareness of tobacco, types of tobacco products used, reasons for initiation, duration, and frequency of use, and knowledge of the harmful effects of tobacco. The simplest language format was used for comfortable understanding even by the youngest subjects.
The questionnaire was pilot-tested on 50 participants for content and factor analysis, and necessary changes were made for the final delivery of the questionnaire. Based on each participant’s submission, responses were assessed. The Cronbach’s α internal consistency coefficient was used to calculate reliability (the value averaged: 0.93).
The study was approved by the Institutional Ethical Committee and the consent of the heads of the relevant institutions and the parents of the school children was obtained. A pretested questionnaire was handed out to participants who agreed to participate and signed informed consent. The survey was performed in front of an examiner who clarified students’ questions about the questionnaire. The questionnaire was returned after being carefully reviewed for accuracy and confidentiality.
To evaluate the data, IBM® SPSS® Version 26.0 was used. When determining significant mean differences (P < 0.05), Chi-square tests were utilized.
RESULTS
Out of 5,266 children inspected, 7.2% (376) school children had ever used tobacco in some form of which 76.3% (287) were boys and 23.7% (89) were girls.
A total of 0.5% (2) of tobacco users were completely ignorant about its harm, 2.9% (11) of them had knowledge about tobacco but were unaware of the harm caused, whereas 96.6% (363) of the users were completely aware of tobacco’s detrimental effects[Figure 1].
Figure 1.
Awareness of tobacco harm across tobacco users
A total of 67.6% (254) of the children had used tobacco due to family influence, 17.6% (66) due to peer pressure, 7.4% (28) to satiate their curiosity, and 3.5% (13) due to emotional agony. In addition, 4.0% (15) were engaged in the habit due to fashionable candor [Figure 2].
Figure 2.
Reasons of tobacco use
For all the questions asked, the difference between men and women was statistically insignificant (P > 0.05). The youngsters who were aware of the several types of tobacco products like gutkha, khaini, bidi, cigarette, and pan masala also knew where to procure them from.
DISCUSSION
The present study assessed the target population in Ahmedabad to find a prevalence of 7.2% (376) of school children consuming tobacco. 7.2% of participants used tobacco and 96.6% were aware of its dangers similar to the study done by Al Haqwi et al.[8] Family influence was a major initiating factor for tobacco use, accounting for 67.6% (254). Peer pressure was the second most prevalent reason accounting for 17.6% (66).
Children love to imitate for a sense of belonging. Maintaining health through tobacco aversion, remained uninteresting. Curiosity and fashionable candor inspired through movies, advertisements or newspapers coupled with emotional agony involving anger, stress, anxiety, or worry made 14.9% of the sample.
Cigarettes and Other Tobacco Products Act (COTPA 2003) forbade advertising and the sale of tobacco products within 100 yards of educational facilities. Despite this, children were found using tobacco. Family and peer influence accounted to 85.2%, which meant children either purchased the products themselves from establishments that did not adhere to the law or obtained the products directly from a family member or friend. Healthcare professionals should be mindful of both.
Limitations
The data is not representative of all juveniles in the 11- to 14-year age range. More nationwide surveys need to be conducted because the current study’s limited sample size cannot accurately represent the adolescent population of a nation like India.
CONCLUSIONS
A total of 96.6% of tobacco users, habits persisted even when they were aware of the possible dangers they posed. Programs to combat tobacco addiction should not only target tobacco use sensitization but also behavioral factors that lead children to self-harm. There is substantial information regarding the dangers of tobacco use; information is dispersed across cell phones, televisions, theaters, roadside banners, educational institutions, and workplaces, as well as on individual tobacco products themselves, etc., Hence, the initiation of these habits should be further probed to find their relation with a child’s usage. It would be irresponsible to assume that habits develop and are maintained because there is a dearth of relevant information in this age. This is the prime reason why despite innumerable efforts made by various institutions, addiction persists. A comprehensive understanding of the complex psychodynamics of childhood addiction helps a child quit the habit.
Enough manpower and resources are used in adult tobacco cessation programs such as the National Tobacco Control Programme (NTCP), Quit India, MPOWER India, Swasthya Mitra, NGO-run programs, etc., but not enough emphasis is placed on preventing initiation in childhood. Cessation research has been solely focused on holding vendors accountable for children’s tobacco addiction, blindsiding healthcare professionals and authorities from the resources available at home and from friends. Measures should be taken to view the supply of tobacco to children in the same perspective as child abuse, just as is done for pornography, alcohol, and recreational drugs.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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