Tobacco use in Kerala: Findings from three recent studies

Background. We reviewed the literature on tobacco use in Kerala and present data from three recently conducted unpublished studies. Methods: Three cross-sectional studies were conducted; a community-based study of 1298 individuals aged 15 years and above (mean age 37.4 years, men 630), a school-based study of 1323 boys (mean age 14.7 years), and a college-based study of 1254 male students (mean age 18.2 years). Information on tobacco use and sociodemographic variables was collected using pre-tested, structured interview schedules and questionnaires. Results: In the community study, 72% of men and 6% of women had ever used tobacco. Compared to men with >12 years of schooling, those with <5 years of schooling were 7 times more likely to smoke (OR 7, CI 3.2-15.6). The age at initiation of smoking was 19 years among those <25 years of age compared to 25.5 years among ever smokers >44 years. In the school study, the age at initiation among boys aged ≤ 13 years was 10.7 years compared with 13.2 years among ≥ 16-year-old boys. Boys whose fathers and friends used tobacco were 2 times and 2.9 times more likely to use tobacco (OR 2.0, CI 1.3-3.1 and OR 2.9, CI 1.6-5.1), respectively, compared with their counterparts. In the college study, 29% of the commerce students used tobacco compared with 5.3% of polytechnic students (p<0.001). Conclusion: Survey data suggest that the age at initiation of tobacco use appears to be falling. A series of cross-sectional studies with larger sample sizes of the youth is required to confirm this impression. Tobacco use habits of fathers and peers are significant influences on youth smoking. There is a need to focus on particular types of colleges as these appear to have high-risk tobacco use environments.