Tobacco and Public Health - TCSC Indonesia

Prevalence among youth
PRAKASH C. GUPTA AND CECILY S. RAY 259
While smoking continues to be a threat, an easily observable trend among youth in
India today is an increasing use of smokeless tobacco. One-third to one-half of
children under the age of ten years in rural areas of different states experiment with
smoking or smokeless tobacco in some form (Vaidya et al. 1992; Kapoor et al. 1995;
Krishnamurthy et al. 1997). Despite Punjab’s tradition of low tobacco use, Punjabi
youth today are falling prey to gutkha, as shown in a recent survey of rural schoolgoing
teenagers in five villages, where two-thirds regularly used it (Kaur and Singh
2002). The popularization of gutkha in urban and rural areas of Gujarat, urban Bihar
and Maharashtra has also been documented (Gupta and Ray 2002). In recent surveys
conducted in secondary schools in Mumbai, about one-fifth of boys used gutkha in the
eighth, ninth, and tenth standards (aged about 13–15 years). In a municipal school,
9% of girls in ninth standard used gutkha and in a private one, 5% of girls in seventh,
eighth, and ninth standards used it. Surveys of street boys in Mumbai have shown that
most start chewing gutkha and smoking bidis by the age of eight years.
Global Youth Tobacco Surveys of representative samples of 13–15-year-old students
have been completed in eleven states in India so far. Between 4.5% to 86.1% students
reported current use of tobacco. A large proportion of children are exposed to second
hand smoke at home and outside. Even at this young age, most smokers reported
wanting to quit and many had made unsuccessful attempts. Only a small percentage
reported having been taught in school about the dangers of tobacco.
Among college students in Maharashtra State, at least one-fifth reported using some
form of tobacco. Cigarette smoking was reported by 10.6%, tobacco chewing by 6.7%,
pan masala by 9.9%, and gutkha by 9.6%—many had more than one habit. Awareness
of the ill effects of tobacco was generally low, especially for smokeless products (Hans
1998). A high prevalence (20–80%) has been observed among medical and dental
students, raising a concern that in future they may not provide appropriate professional
advice to tobacco users.
Reasons for tobacco use
There are a wide variety of reasons why people use tobacco. Among lower socioeconomic
strata, people often use it to suppress hunger. In rural areas, people believe
that tobacco has medicinal properties to cure or palliate common discomforts, like
toothache, headache, and stomachache. Children copy the behaviour of their parents
and other elders. People are largely unaware of the dangers posed by tobacco. Young
working boys start smoking because they see others smoking and local shopkeepers
give bidis to young boys to attract them for work. Labourers use smoking as a pretext
to take a break from work.
The most common reason amongst children of the urban poor is their film hero who
smokes. In higher socio-economic classes, children may smoke due to peer pressure,