tobacco_use

MASTER OF PUBLIC HEALTH IN SOCIAL EPIDEMIOLOGY

2014-16

SCHOOL OF HEALTH SYSTEM STUDIES

TATA INSTITUTE OF SOCIAL SCIENCES

MUMBAI

RURAL INTERNSHIP REPORT

INTERNSHIP ORGANISTION – VATSALYA

LUCKNOW DISTRICT, UTTAR PRADESH

Individual Study- Health issue and its social implication

To assess the pattern, frequency of tobacco consumption and the factors

leading to its use among the adolescents in rural Lucknow

Under the guidance of: Submitted by:

Prof. Anil Kumar Dr. Akanksha Verma

Professor, School of M2014PHSE002

Health system studies

Tata Institute of Social Sciences

Mumbai

CONTENTS

1. ACKNOWLEDGEMENTS

2. ABSTRACT

3. INTRODUCTION

4. LITERATURE REVIEW

5. RATIONALE

6. AIMS

7. METHODOLOGY

8. RESULTS

9. DISCUSSION

10. CONCLUSION

11. RECOMMENDATIONS

12. REFERENCES

13. APPENDIX

Acknowledgement

At this juncture of the completion of my internship presentation and

report writing I would like to take this opportunity to express my heartfelt

gratitude to thank each and everyone who helped me during this

internship

First of all I would like to thank the Almighty for always showering his

blessings on me and giving me this life and all the other blessings.

I would also like to thank all the internship coordinators for giving us

this opportunity in the form of this rural internship to explore the new

facts and get new experiences in a rural setting.

I would also take this opportunity to sincerely thank Prof.Anil Kumar

sir for providing his valuable guidance and support throughout the period

of internship and helping me shape my vision and improve my skills and

also learn the intricacies of working in a very different setting

I would also like to thank School of health system studies, Mumbai for

the valuable support.

Also a sincere thanks to Vatsalya, Lucknow and especially Dr.Neelam

Singh for giving me this opportunity to be a part of such a respected

organisation and give me this opportunity to work in a different setting.

In the end I would like to thank my Family, especially my parents for

their tireless effort and support in making me capable to reach this stage

in my life.

Abstract:

Aim

To assess the pattern, frequency of tobacco consumption and the factors leading to its use

among the adolescents

Methodology:

It was a cross sectional study quantitative study. Two type of sampling was .done in order to

collect the school dropouts and the school going children. Adolescents in the age group of 10

to 19yrs were takes

Results:

Majority of the respondents were from 10 to 13yrs of age whereas respondents from 14 to

16yrs and 17 to 19 yrs. constituted 37.7 % and 22.6% of the population respectively.

73.3% of the respondents were males whereas 26.7% were the female respondents

Majority of the respondents were Hindus which constituted about 74.7%of the total

respondents whereas Muslims constituted around 25.3% of the population. Of the total

respondents 79.5% of the respondents were presently going to school while the rest were

school drop-outs. When asked about the ever use of tobacco 45.2% said that they have

consumed it once in their life. While 41.8% said that they are currently using it in some form

or the other. When asked about the most frequent and most common form of consumption,

smokeless tobacco consumption was seen to be the most common form of consumption.

While asking about the age of initiation of tobacco consumption majority of the respondents

said that they had starts at an early age of less than 10 yrs. For others it was between 10 to 13

yrs. One important fact which came to light was that while comparing the age of initiation for

the previous generation, for the current generation it has reduced

Reason of initiation for around 11.6% was curiosity whereas for 14.6% was peer pressure and

for the rest 18.5% it was the use by any family member

Conclusion:

The study to assess the frequency and pattern of tobacco consumption on the adolescent in a

rural setting in Luck now in Uttar Pradesh bout many interesting facts into lime light.

Considering the age of the respondents, majority belonged to the age group 15 tp 19 yrs while

a small proportion was from the age group of 10 to 14 yrs.

Majority of the respondents were males. Further it was seen that majority of the respondents

had used some form of tobacco in the past and a large segment of it was currently using it.

Further it was seen that education status of the respondent and presently going to school had a

positive impact on reducing the no. of adolescents who were consuming any form of tobacco.

Peer pressure along with curiosity were seen as the major reasons for initiating the use of

tobacco in any form.

Introduction

Adolescence is a major period of transition, it is the change from a small child to a full grown

adult. This period is also the period for the acquiring of various forms of behaviours which

may have ill effects in the future.

India has been considered as one of the youngest countries in the world as the population of

the age group between 10 to 19 yrs. of age which is called the most productive population.

But this population if not properly harnessed and taken care of may in no time become a

liability rather than an asset to the nation.

It has been very well established that the habit of tobacco consumption has been on an

upward trajectory in the developing countries. And this burgeoning silent epidemic is

spreading at a very fast pace among the adolescents. Adolescents are the most vulnerable

population to initiate tobacco use. It is now well established that most of the adult users of

tobacco start tobacco use in childhood or adolescence

The consumption of tobacco is a major cause of health damage, worldwide. Of the 10 million

deaths each year by 2025 seven million deaths will occur in the developing countries, mainly

in China and India. It has been estimated that 250 million children and adolescents who are

alive today would die prematurely because of consumption of tobacco, most of them in the

developing countries. Tobacco use in India is a major health problem starting during early

adolescence. Understanding the nature of the problem is crucial to undertake urgent steps to

National Household Survey of the drug and alcohol abuse in India 2010 has quoted the

prevalence of tobacco use among 12-18 years old as 55.8%. Tobacco-related health hazards

have been a major area of concern especially in a developing country like India. Accounting

for the reason of 5 million deaths per year, tobacco has emerged as a deadly addiction with

increased susceptibility towards the adolescent and early adulthood age groups to curb the

menace of tobacco use.

The World Bank in one of its reports has stated that reported nearly 82,000-99,000 children

and adolescents all over the world begin to smoke every day and about half of them would

continue to smoke thought their adulthood and half of these adult smokers will die due to

smoking and its related diseases.

There are only a few studies on prevalence and initiation of smoking and smokeless tobacco

use among children in our country. The risks of tobacco use are highest among those who

start early and continue its use for a long period. The early age of initiation underscores the

urgent need to intervene and protect this vulnerable group from falling prey to this

addiction6. The most common reasons cited for children to start using tobacco are peer

pressure, parental tobacco habits and pocket money given to children.

Literature review:

In one of the study which was done to find the tobacco use among adolescent boys in

Trivandrum city, Kerala, it was seen that the Prevalence of current tobacco use was 11.3%.

Tobacco use was 2.9 times higher among older boys compared to younger boys. Whereas for

the girls the prevalence was much less. The major reason for high prevalence of tobacco

among boys was peer pressure. (Sailesh Mohan, & P. Sankara Sarma,)

Another study which was conducted in order to study the pattern of tobacco use among rural

adolescents (15-19 years) and to access the reasons for use and non-use of tobacco products,

revealed that about 68.3% boys and 12.4% girls had consumed any tobacco products in last

30 days. Among the boys kharra, and gutka were the major products which were used .

Among boys, 51.2% showed that it was due to peer pressure, 35.2% consumed tobacco as

they felt better, and five percent consumed tobacco to ease abdominal complaints and dental

problem. Among girls, dry snuff for teeth cleaning, and gutka and tobacco & lime were

most commonly used The reasons for non-use of tobacco among girls were fear of death

from cancer , poor oral health . (AR Dongre, PR Deshmukh, N Murali, BS Garg)

Another study which was done in order to assess the impact of socio economic status ofn the

increased prevalence of tobacco consumption showed that prevalence rate for ever-use of any

tobacco product was much higher for government school students, compared with private

school students (p<.01). Students in government schools showed a lower score than private

school students on most psychosocial risk factors for tobacco use, indicating higher risk..(

Charu Mathur,& Melissa H. Stigler,)

Another study which was conducted in the rural district of Jamnagar showed that 33.12% of

the adolescents were addicted with one or other type of tobacco chewing, majority of

addicted adolescents were in the age group of 17- 19 years (36.26%). Tobacco chewing is the

most frequent form of using tobacco by adolescents than smoking. Majority of the

adolescents were addicted for more than 12 months (57.47%). Main inducing factor for

addiction was found to be friends (61.69%) (Naresh R. Makwana Viral R. Shah Sudha Yadav

)

In another community based study which was conducted in one of the rural districts of

Karnataka showed that Students who were in government schools, especially the male were

more likely to use tobacco than students who were in private schools, female, younger, and in

eighth grade. The increase in tobacco use by age within each grade was larger in sixth grade

than in eighth grade in government schools, with older sixth-grade students at especially high

risk. ( the lancet 2010)

http://www.sciencedirect.com/science/article/pii/S0091743505000459

http://ntr.oxfordjournals.org/search?author1=Melissa+H.+Stigler&sortspec=date&submit=Submit

Rationale:

Adolescents are an important resource of any country. Adolescents comprise 20% of the

world’s total population .out of 1.2 billion adolescents world-wide, about 85% live in

developing countries .In India there are 190 million adolescents comprising 21% of India’s

total population

India, with 327 million adolescents, has one of the youngest populations in the world, with

these adolescents constituting approximately 21% of the total population UP with 200 million

population and of which 10 to 19yrs comprise around 24.5% of this population poses a huge

burden. .

Tobacco use is a leading cause of preventable deaths world over, more so in developing

countries. In India alone, nearly 1 in 10 adolescents in the age group 13-15 yr have ever

smoked cigarettes and almost half of these reports initiating tobacco use before 10 yr of age1.

The tobacco situation in India is unique because of a vast spectrum of tobacco products

available for smoking as well as smokeless use

Tobacco use among school children is becoming a serious problem in developing

countries. The early age of initiation underscores the urgent need to intervene and

protect this vulnerable group from falling prey to this addiction

Moreover, there is enough evidence to believe that a majority of smokers start the tobacco

use before 18 years of age in India. The early age of initiation underscores the urgent need to

intervene and protect this vulnerable group from falling prey to this addiction. The present

study was thus undertaken to assess the prevalence of tobacco habits among school children,

determine the age of initiation of these habits

Therefore understanding the dynamics of the tobacco consumption and the factors leading to

it will surely help in reducing the footprints of the epidemic in disguise

Aim

To assess the pattern, frequency of tobacco consumption and the factors leading to its use

among the adolescents

Objectives:

1. To study the prevalence of tobacco consumption among adolescents.

2. To study the level of knowledge about the ill effects of tobacco consumption.

3. To study the socio-economic factors impacting tobacco consumption among the

adolescents

4. To study the consumption patterns and correlates of tobacco use among adolescent

school children and school drop-outs in the two villages.

Research methodology

1. Universe of study:

Bithauli Khurd village and Raipur village in Bithauli Khurd panchayat in Chinhat block of

Lucknow district in western Uttar Pradesh

2. Type of Study:

It was a cross sectional study quantitative study

3. Sampling frame :

Adolescents in the village of Bithauli Khurd and Raipur village in Bithauli Khurd panchayat

4. Sampling:

Two type of sampling was .done in order to et the school dropouts and the school going

children.

In order to collect the sample of the school going children, probability proportional to size

sampling was done. Under this the list of all the adolescents studying in both government and

private colleges in Bithauli Khurd panchayat were obtained from the schools and then PPS

sampling was done

In order to collect the sample from school drop-outs, snow ball sampling was done.

5. Sample size:

A total of 146 respondents were interviewed of which, 38 were school drop-outs and 108

were school going children

6. Methods of data collection:

A qualitative method was used for the data collection which included face to face interviews

with 146 respondents in the two villages which consisted of 38 dropouts and 106 school

going adolescents in the age group of 10 to 19 yrs of age

7. Tool used: Semi-structured interview schedule was used which was translated and conducted in Hindi.

Ethical consideration: Verbal consent was taken from the respondents prior to the interview

and participation was made voluntary. Respondents were assured of confidentiality.

Participants were free not to answer any question with which they were not comfortable and

could leave the interview at any point of time

Results;

Basic demographic data:

Age of the respondents:

Majority of the respondents were from 10 to 13yrs of age whereas respondents from 14 to

16yrs and 17 to 19 yrs. constituted 37.7 % and 22.6% of the population respectively.

Gender


48.6%

37.7%

22.6%

Religion of the respondent

Majority of the respondents were Hindus which constituted about 74.7%of the total

respondents whereas Muslims constituted around 25.3% of the population

Educational status of the respondent

Of the total respondents 79.5% of the respondents were presently going to school while the

rest were school drop-outs

74.7%

Taking the education status of the respondents around 48% had primary education while 39%

had middle level of education and rest had no education

Reason for not going to school

While enquiring about the reason for not going to school the major theme which came to

notice was the necessity to support the family while the other important theme which came

out was the lack of the resources to support the education of the respondent

Monthly income of the household

For the majority of the households the monthly income ranged from 1000 to 4999 and for the

rest it ranged from 5000 to 9999 and up to 1000. only for a small fraction i.e 2.8% the

monthly income is 10000 and above

Financial status of the drop out:

Majority of the drop-outs had a monthly income in the range of Rs1000 to Rs.4999 i.e

25.85% and for the rest 2.7% it was in the range of 5000 to 9999

56.8%

Patterns about tobacco consumption

When asked about the ever use of tobacco 45.2% said that they have consumed it once in

their life

While 41.8% said that they are currently using it in some form or the other.

When asked about the most frequent and most common form of consumption, smokeless

tobacco consumption was seen to be the most common form of consumption.

45.2%

41.8%

Frequency and form of use

Majority of the respondents said that they had consumed tobacco at least once in the past one

week while around 26% said that they had consumed two to four times in the past one week

and only a small fraction said that they consumed tobacco more than 4 times in the past one

week

When asked about the most common form of tobacco consumption majority said that it was

the smokeless form of tobacco

26%

35.4

%

Age of initiation of the respondent and the family member



yrs. One important fact which came to light was that while comparing the age of initiation for

the previous generation, for the current generation it has reduced

Reason for initiating:



Taking the most common forms of consumption were gutka, kahini , zarda and beetal nut

among the boys who were using smokeless form of tobacco where as for the adolescent girls

the most common form of consumption was supari , mishri and for a very small section it was

beetal nut.

Source of money

Taking into account the major sources of money included pocket money, money given for

other jobs, money given by siblings and self employed

Does any one uses these products

43.2% of the respondents said that there was someone in the house who was using tobacco in

some form

43.2%

When asked about any of the family members using tobacco in any form 43.2% said yes they

were using and for the majority of the respondents the father or the siblings were using it

In about 17,1% of the cases it was the father who was using tobacco in some form or the

other while in 11.2T% of the respondents it was the sibling who was using tobacco in some

form

Impact of education

Have you ever tried

tobacco

Education status Yes No

No education 10 0

Primary 54 60

Middle school 11 6

High school 1 4

Education had a significant impact on the consumption practices. It was found that there was

a significant relationship (P-0.004) between those who had higher education status and ever

usage of tobacco

17.1%

8.9%

11.2%

Presently going to school and tobacco consumption

Of those who were presently going to school majority of them were not using any form of

tobacco whereas the consumption rate among the drop-outs was high. There was a significant

relationship (P-0.001)

Gender of the respondent

Presently using

any form of

tobacco

Gender of

the

respondent

Female

Male

No yes

41 8

54 43

Gender also had a positive role in less consumption of tobacco .it was highly significant.(P-

0.001) it was seen that any form of consumption was less in the females as compared to the

males

Currently using any form

of tobacco

Presently going to

school

no

yes

No yes

10 29

85 22

Impact of family member using it

Respondent

presently

using

tobacco

Anyone in

the house

currently

using

tobacco in

any form

No

Yes

no Yes

54 29

31 32

The use of tobacco in any form had a positive impact on the enhanced consumption of

tobacco among the adolescents (P-0.003)

Assess ability of these products and current usage

Currently

using any

form of

tobacco

Are these

products

easily

available

no

yes

no yes

71 4

14 61

Accessibility and easy availability of these products also had a significant impact on the

increased consumption of tobacco among the elderly (P-0.001)

Realised the expenses in buying

Only 7.5% said yes and it ranges from less than 10rs. To 10 to 20 Rs per day. The rest said

that they never considered or thought about the expenses made on tobacco consumption.

Sign of assertiveness

Only around 26% of the respondents said that they thought that consumption of tobacco is a

sign of assertiveness whereas majority of the respondents did not consider to be a sign of

assertiveness

Questions about stopping it

Around 25% of the respondents said that they wanted to stop the consumption of tobacco

whereas 46% said that they did not think about it.

Tried stopping in the past

Majority of the respondents when asked about their wish to stop this habit, said that they did

not wish to stop this habit or they have never thought of stopping the habit. Further only a

small section said that they wanted to stop this habit

Received help:

Majority of the respondensants said that they did not receive any formal information or help

to stop the habit

Those who received any kind of help and support said that they got help, mainly from the

other family members or siblings and only a very small section of the respondents said that

they received any kind of formal help

Discussion

Taking the age of the respondents majority were from 10 to 13yrs of age whereas respondents

from 14 to 16yrs and 17 to 19 yrs. constituted 37.7 % and 22.6% of the population

respectively.


Majority of the respondents were Hindus whereas Muslims constituted around 25.3% of the

population. Of the total respondents 79.5% of the respondents were presently going to school

while the rest were school drop-outs. 48% had primary education while 39% had middle level

of education and rest had no education

Main reason cited for leaving school was to support the family while the other important

theme which came out was the lack of the resources to support the education of the

respondent. For the majority of the households the monthly income ranged from 1000 to 4999 and

for the rest it ranged from 5000 to 9999 and up to 1000. Only from a small fraction i.e 2.8% the

monthly income is 10000 and above

45.2% of the respondents said that they have consumed it once in their life. While 41.8%

said that they are currently using it in some form or the other. Smokeless tobacco

consumption was seen to be the most common form of consumption.

Majority of the respondents said that they had consumed tobacco at least once in the past one

week while around 26% said that they had consumed two to four times in the past one week

the smokeless form of tobacco was seen as the most common form of tobacco consumption.



yrs.



Taking the most common forms of consumption were gutka, kahini , zarda and beetal nut

among the boys who were using smokeless form of tobacco where as for the adolescent girls

the most common form of consumption was supari , mishri and for a very small section it was

beetal nut.

Taking into account the major sources of money included pocket money, money given for

other jobs, money given by siblings and self employed

When asked about any of the family members using tobacco in any form 43.2% said yes they

were using and for the majority of the respondents the father or the siblings were using it

In about 17,1% of the cases it was the father who was using tobacco in some form or the

other while in 11.2T% of the respondents it was the sibling who was using tobacco in some

form

Education had a significant impact on the consumption practices. It was found that there was

a significant relationship (P-0.004) between those who had higher education status and ever

usage of tobacco

Of those who were presently going to school majority of them were not using any form of

tobacco whereas the consumption rate among the drop-outs was high. There was a significant

relationship (P-0.001)

Gender also had a positive role in less consumption of tobacco .it was highly significant.(P-

0.001) it was seen that any form of consumption was less in the females as compared to the

males

The use of tobacco in any form had a positive impact on the enhanced consumption of

tobacco among the adolescents (P-0.003)

Accessibility and easy availability of these products also had a significant impact on the

increased consumption of tobacco among the elderly (P-0.001)

Only 7.5% said yes and it ranges from less than 10rs. To 10 to 20 Rs per day. The rest said

that they never considered or thought about the expenses made on tobacco consumption.

Those who received any kind of help and support said that they got help, mainly from the

other family members or siblings and only a very small section of the respondents said that

they received any kind of formal help

Conclusion:

The study to assess the frequency and pattern of tobacco consumption on the adolescent in a

rural setting in Luck now in Uttar Pradesh bout many interesting facts into lime light.

Considering the age of the respondents, majority belonged to the age group 15 tp 19 yrs while

a small proportion was from the age group of 10 to 14 yrs.

Majority of the respondents were males. Further it was seen that majority of the respondents

had used some form of tobacco in the past and a large segment of it was currently using it.

Further it was seen that education status of the respondent and presently going to school had a

positive impact on reducing the no. of adolescents who were consuming any form of tobacco.

Peer pressure along with curiosity were seen as the major reasons for initiating the use of

tobacco in any form.

Further it was also found out that adolescents whose family members were using any form of

tobacco had an increased tendency of consuming tobacco.

One interesting fact which came to lime-light was that the age of initiation of consumption of

these products has been drastically reduced i.e for the early generation it was around 17 to 20

yrs where as for the present generation it has come down to less than 10 yrs in many cases

and around10 to 13 yrs. in other respondents.

The study shows the changing trends and patterns of the consumption of tobacco among the

adolescents, further it shows the changed patterns of socialisation, peer pressure lack of

counselling services and other rehabilitative services which further impede this

Recommendations:

1. More and better awareness generating activities should be initiated in the schools in

the curriculum in order to spread more awareness among the students.

2. School drop-outs is one of the very important sections which are highly susceptible to

initiating tobacco consumption, therefore special focus needs to be given to this

section in the form of providing counselling through various sources.

3. Rehabilitative centres should be established as focal points in order to cater to the

needs of those who are currently using these.

4. Although laws are there to prevent the sale of these products to the minors, still the

loop-holes in these laws make them without teeth and thus increase the accessibility

to the minors. This should be checked in order to tackle this burgeoning epidemic.

References:

Prevalence and Pattern of Tobacco Consumption in IndiaSoni Preeti and Raut D.K.(2013)

The Relationship Between Tobacco Advertisements and Smoking Status of Youth in India

Payal B Shah, Mangesh S Pednekar, Prakash C Gupta, Dhirendra N Sinha (2010)

Tobacco use by Indian adolescents Chadda RK, Sengupta SN

Global youth tobacco survey 2013

Assessment of Pattern and Profile of Substance Use among Children in India Conducted for

National Commission for Protection of Child Rights (NCPCR)

CORRELATES OF TOBACCO USE AMONG MALE ADOLESCENTS IN SCHOOLS OF

HALDWANI, NAINITAL S. Awasthi, S.K. Jha, C.M.S. Rawat, S. Pandey and S.S. Swami

(2014)

Appendix:

Socio demographic data

1. Age of the respondent

a. 10 to 13yrs.

b. 14 to 16 yrs.

c. 17 to 19 yrs.

2. Gender of the respondent

a. Female

b. Male

3. Religion:

Hindu

Muslim

Christian

Other, please specify ________________________

4. Presently going to school

a. Yes

b. no

5. Educational status of the respondent

a. No education

b. Primary

c. Secondary

d. Above secondary

6. Reason for not going to school

a. No resources

b. Support the family

c. Doesn’t want to study

d. Other

e. Not applicable

7. Education of the mother

a. Illiterate

b. Primary

c. Secondary

d. Above secondary

8. Education of the father

a. Illiterate

b. Primary

c. Secondary

d. Above secondary

9. Occupation of the mother

a. House job

b. Farming

c. Service

10. Occupation of the father

a. House job

b. Farming

c. Service

11. Monthly income of the household

12. Monthly income of the drop-out

Questions about tobacco and smoking

13. Have you ever used Tobacco?

Yes

No

14. Do you currently use Tobacco?

Yes

No

15. What are the consumable forms of tobacco that you ever used

Zarda

Khaini

Gutka

Nasal/ oral snuf

Mishri

Pan

paan masala

Chewed pan with tobacco

Cigarette

hand-rolled cigarettes or bidi

hookah

supari

Any other form, specify ________________

16. frequency of tobacco use

a. Once in the past week

b. Two to four times in the past week

c. More than four times in the past week

17. Has the frequency of intake increased since your first try

a. Yes

b. No

18. Age of initiation of consumption

a. Less than 10yrs

b. 10 to 13yrs

c. 13+ yrs.

19. Various forms of tobacco you take

a. Smokeless

b. Smoking

c. Both

20. Reason for initiating tobacco use

a. Curiosity

b. Peer pressure

c. Family member uses it

d. Social acceptance

e. Others

21. Have you ever realised the total money you spend monthly in buying these products

A. Yes

B. No

22. Expenses per day in buying alcohol and other products

23. From where do you arrange the money to buy these products?

a. Pocket money

b. Save the money given for other household works

c. Elder sibling

d. Himself / herself (employed)

Questions about the availability, accessibility of the product

24. Do you find it easy to get access to these products

a. Yes

b. No

25. Do you know that till a certain age it is illegal to sell these products to the minor

c. Yes

d. No

26. Are these products easily available outside your school premises or near your home

e. Yes

f. No

Reasons for initiating tobacco consumption or cigarette smoking

27. Does anyone in your house uses these products

a. Yes

b. No

28. If yes, who ( multiple options)

a. Father

b. Mother

c. Brother

d. Others

29. What was the age of initiation of using these products for that family member/

a. Less than 10 yrs.

b. 10-13 yrs.

c. 14 to 16 yrs.

d. 16+ yrs.

30. What prompted you to use Tobacco for the first time?

Curiosity

Peer pressure

Parents or members of the family using tobacco

Socially acceptable

Don’t remember

Don’t want to mention

any other reason, specify

31. Did your family members know of your tobacco use?

Yes, they knew about my Tobacco use

No, they did not know about my Tobacco use

Don’t know

Refused

32. Do you think that tobacco consumption of cigarette smoking is a sign of assertiveness

a. Yes

b. No

33. Do you think tobacco consumption / smoking leads to reduction in stress?

a. Yes

b. No

34. Do you think that the frequency of the intake increases during stressful situations

a. Yes

b. No

The next questions ask about your feelings toward stopping smoking

35. Do you want to stop smoking now/ tobacco consumption?

g. Yes

h. No

i. No applicable

36. During the past 12 months, did you ever try to stop tobacco consumption?

a. Yes

b. No

37. What were the hurdles that you faced while trying to stop tobacco consumption?

a. Irritability

b. Urge to start again

c. Change in mood

d. Lack of sleep

38. . Have you ever received help or advice to help you stop tobacco

consumption?

a. I have never smoked

b. Yes, from a program or professional

c. Yes, from a friend

d. Yes, from a family member

e. others

The next questions ask about your exposure to other people’s smoking.

39. During the past 7 days, on how many days has anyone smoked inside your home, in

your presence?

a. 0 days

b. 1 to 2 days

c. 3 to 4 days

d. 5 to 6 days

e. 7 days

40. During the past 7 days, has anyone smoked in your presence, inside any enclosed

public place, other than your home

a. yes

b. no

41. during the past 30 days, has anyone smoked inside the school building or outside on

school property?

a. Yes

b. No

The next questions ask about your knowledge of messages that are against using

tobacco (might include cigarettes, other smoked tobacco, and smokeless tobacco).

42. During the past 30 days, did you see or hear any anti-tobacco media messages on

television, radio, internet, billboards, posters, newspapers, magazines, or movies?

a. Yes

b. No

43. During the past 30 days, did you see or hear any anti-tobacco messages at sports

events, fairs, concerts, or community events, or social gatherings?

a. Yes

b. No

44. Did you see any health warnings on cigarette or tobacco packages?

a. Yes,

b. No

45. What do you think about these warning?

a. it made me think of quitting the habit

b. I did not think of it much

c. I did not bother about it much

46 .During the past 12 months, were you taught in any of your classes about the dangers of

tobacco use?

a. Yes

b. No

c. I don’t know

47. Does tobacco consumption has a detrimental effect on your health

tobacco_use

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