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Table of Contents
Year : 2019  |  Volume : 20  |  Issue : 1  |  Page : 69-72

Knowledge and practice on tobacco use in school students, Nagaland

1 Burrows Memorial Christian Hospital, Cachar, Assam, India
2 Baptist Christian Hospital, Tezpur, Assam, India
3 Ramakrishna Mission Hospital, Itanagar, Arunachal Pradesh, India
4 Kohimas Hospital, Kohima, Nagaland, India
5 College of Nursing, CIHSR, Dimapur, Nagaland, India

Date of Web Publication09-Oct-2019

Correspondence Address:
Ms. Alem Purnungla Aier
College of Nursing, CIHSR, 4th Mile, P.O. ARTC, Post Box - 31, Dimapur - 797 115, Nagaland
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJCN.IJCN_6_19

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Tobacco use is a leading cause of preventable deaths all over the world, more so in developing countries. The most common reasons cited for children using tobacco are peer pressure, parental tobacco habits and pocket money given to children. The present study highlights the knowledge and practice of school students regarding tobacco in some selected schools in one district in Nagaland. A sample of 325 participants was selected using total enumerative sampling technique. The study findings revealed that the overall knowledge of the students regarding tobacco was 62.25% and practice of tobacco use was 57.2%. The knowledge and practice was found to be statistically significant (P < 0.05). There was statistically significant association between practice and gender (P < 0.05) and type of schools with knowledge (P < 0.05). This study clearly indicates the need for primary prevention of tobacco intake/use as an important part of health education to schoolchildren to assist the students to understand the consequences of tobacco and thereby prevent the consumption of tobacco.

Keywords: Knowledge, practice, school students, tobacco use

How to cite this article:
Singha AS, Malandia B, Rema H, Mor K, Aier AP. Knowledge and practice on tobacco use in school students, Nagaland. Indian J Cont Nsg Edn 2019;20:69-72

How to cite this URL:
Singha AS, Malandia B, Rema H, Mor K, Aier AP. Knowledge and practice on tobacco use in school students, Nagaland. Indian J Cont Nsg Edn [serial online] 2019 [cited 2021 May 8];20:69-72. Available from: https://www.ijcne.org/text.asp?2019/20/1/69/268698

  Introduction Top

Adolescents, in today's world, are increasingly exposed to changing lifestyles that have a very negative impact on health. Addictions developed in adolescence are likely to persist into adult life. One such addiction, tobacco use, in children and adolescents is reaching pandemic levels. The World Bank has reported that between 82,000–99,000 children and adolescents all over the world begin smoking everyday. About half of them will continue to smoke into adulthood, and half of the adult smokers are expected to die prematurely due to smoking-related diseases.[1] Tobacco is used in a variety of ways in India; its use has unfortunately been well recognised among the adolescents. Tobacco addiction of a large number of adults is initiated during adolescence. The India Global Youth Tobacco Survey, a school-based survey of students in Grades 8, 9 and 10, was conducted in 2009. A total of 10,112 students aged 13–15 participated in the study. It showed that 14.6% of the students were using tobacco, 4.4% smoked cigarettes and 12.5% used some other forms of tobacco. Of 1000 teenagers who smoke today, 500 will eventually die of tobacco-related diseases, 250 in their middle age and 250 in their old age. Tobacco use in adolescents has been called a 'paediatric epidemic' because of the increasing level of its use and dire public health implications.[2]

The most common reasons cited for children to start using tobacco are peer pressure, parental tobacco habits and pocket money given to children.[3] The risks of tobacco abuse are highest among those who start early and continue it 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 addiction.

Nagaland is the second-highest consumer of tobacco in the Northeast with a prevalence rate at 57% smokers. Cigarette accounts for 26.3% as the most common form of tobacco, followed by other gutkha products. As per the Nagaland School Oral Health Survey 2014 report, 28.3% of school-going children are smokeless tobacco users, while 14.8% are into smoking habits and 41.2% children are engaged by parents to buy tobacco. Actual disease burden due to tobacco in Nagaland is still uncertain as no detailed survey has been carried out. However, the independent survey conducted by the Government of India gave enough evidence that there is a serious disease burden in the state.[4] Shrivastava et al.[5] conducted a study on the 'Prevalence of Smokeless Tobacco Among School Going Adolescent Students of Raipur City, Chhattisgarh, India'. The study revealed that the mean age of students in the study was 15 years. The prevalence of smokeless tobacco consumption was 10%. Majority were male with 80.9% users, and the mean age of initiation was 13 years. Peer pressure (76%) was the most common reason for initiation. Pocket money (57.1%) was found to be the major source of purchasing. The study also indicated a strong association of family member's tobacco use and promotional advertisement.

A cross-sectional questionnaire-based survey conducted by Narain et al.[6] revealed that the mean age of initiation of tobacco intake was around 12.4 years. More than 50% of the tobacco chewers reported the use of khaini at least once. Nearly 70% of the boys and 80% of the girls <15 years initiated the habit of tobacco before the age of 11 years. Significant early uptake of tobacco chewing was reported from private school students as compared to government school students (P< 0.05). Knowledge and practice was significantly associated with gender (P< 0.05). Knowledge and type of schools were also significantly associated (P< 0.05). There has been growing evidence of tobacco intake among adolescents due to media influence, easy and cheap availability, peer pressure, etc. Hence, the aim of this study was to assess the knowledge and practice of schoolchildren regarding tobacco use which will facilitate the creation of an awareness programme on the ill effects of tobacco.


  • To assess the knowledge of school students regarding tobacco
  • To assess the practice of tobacco use among school students
  • To determine the association of knowledge and practice with selected demographic variables of school students.

  Methodology Top

An exploratory research design was adopted for the study. The study was conducted in selected schools in a city in Nagaland. The target population was the students studying in Class IX and X. The sampling method used was total enumerative sampling technique. The study was approved by the Nursing Research Committee, College of Nursing, CIHSR. Permission was obtained from the school authorities and informed consent was obtained from the participants who fulfilled the inclusion criteria. The inclusion criteria to participate in the study were the school students in Class IX and X who were present during the study period. The sample size was calculated using the formula n = 4 (p × q)/d2. A self-structured questionnaire was prepared by the investigators after a thorough review of literature, and it was validated by four experts. The knowledge questionnaire included questions on knowledge on tobacco and its ill effects and practice items on patterns of tobacco usage. The content validity of the instrument was 91% for knowledge and 100% for practice. Data were collected from 325 participants. Anonymity and confidentiality were maintained. The study was based on the Pender's Health Promotion Model. Descriptive statistics were used to describe the demographic variables. Chi-square test was used to assess the association between knowledge and practice scores with some selected demographic variables. P < 0.5 was considered statistically significant.

  Results And Discussion Top

Majority of the participants were in the age group of 16–18 years (56.60%), and 61.50% were females [Table 1].
Table 1: Distribution of students based on demographic variables

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[Figure 1] shows that the 51% of the school students had very good knowledge on tobacco.
Figure 1: Distribution of students based on knowledge on tobacco (N-325).

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[Figure 2] shows that 57.2% of the participants had experimented with tobacco.
Figure 2: Distribution of students based on the use of tobacco (N-325).

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The most common type of tobacco products consumed was the pan masala. Pressure from friends was the most influencing factor of tobacco use, where the participants also stated that the reason why they take tobacco was because friends take tobacco [Table 2]. In the current study, 167 participants tried quitting tobacco, where only 110 were successful in quitting the habit. The most common reason stated for trying to quit tobacco was the realisation of the harmful effects of tobacco.
Table 2: Distribution of school students based on practice of tobacco usage

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The study revealed that there was no association between knowledge and gender, whereas a significant association was found between the practice and gender (P< 0.05), type of school and knowledge of tobacco (P< 0.05) and knowledge and practice (P< 0.05).

The study findings revealed that the mean knowledge score was 62.25%. Majority (88.6%) were aware that tobacco is injurious to health and 74.46% knew that passive smoking is harmful. Most (92%) also knew that it can cause oral cancer (85.8%). This finding is similar with a study conducted by Hirani and Balaramanamma[7] which showed that of 2842 students, 69.1% of them were aware that tobacco is hazardous to health and 26.3% students knew that passive smoking is harmful. One-fourth of them were aware about anti-tobacco messages. Another study conducted by Prasanth and Megha[8] found that the awareness that tobacco is injurious to health was found in 99.66% of the total participants. Among the health problem related to tobacco use, cancer was mentioned by 82.6% of the participants and lung diseases by 29%. The findings of this study and other studies reveal that most children knew the ill effects of tobacco use.

This study revealed that 186 (57.20%) students had experimented with tobacco and 139 (42.70%) did not. About 21% were regular users, 22.50% were occasional users, 31.70% revealed about the past use and 24.70% revealed to have used tobacco just to experiment. The most common tobacco form used was pan masala (63.90%) followed by cigarette (9.10%) and others (27.90%). It was also identified that the age of initiating tobacco intake was 11–16 years. This study is similar with a study conducted by Kumar et al.,[9] on the 'Psychosocial Determinants of Tobacco Use among School Going Adolescents in Delhi, India'. The study revealed that most of the students (53.3%) initiated tobacco smoking at 13 years of age and 26.4% of the students initiated tobacco smoking at 12 years of age, with a mean age of initiating tobacco smoking being 12.3 years. The study revealed that the most influencing factor for initiating tobacco was peer pressure (47.80%). The same study identified that parents of the participants (fathers [54.10%] and mothers [20.20%]) consume tobacco. In the present study, the most influencing factor for initiating tobacco was peer pressure (47.8%) which is consistent to the study conducted by Imtiaz et al.,[10] where the most common reason for initiating tobacco use was found to be peer pressure and smokeless tobacco was the most common form of addiction among the adolescents.

The present findings contradict the findings of a study conducted by Mukherjee et al.,[11] where they found that knowledge score was higher in females, students from nuclear families and those with literate parents. In this study, there was no association between knowledge and gender. The significant association between knowledge and practice and the age of initiation (11–16 years of age) implies that education about hazards of tobacco use and awareness of the complications of tobacco needs to be reinforced among the school students. Cessation programmes relating to tobacco use which specifically targets the adolescents should be taken into consideration at all levels. The results of the study clearly indicate the need for primary prevention of tobacco intake through health education to school students to help them resist peer pressure and make their own decision not to take tobacco, with an enhanced understanding about the consequences of tobacco use. Raising awareness of these problems and providing some baseline information is important in designing appropriate interventions for future monitoring strategies. At the same time, tobacco-free environment should be ensured for children, and joint education for children along with parents and teachers would be very necessary because the parents and teachers themselves may not be aware about the negative impact of tobacco has on the physical and mental development of the students. Anti-tobacco campaigns and celebration of 'World No Tobacco Day' every year in the schools should be emphasized.

  Conclusion Top

The study suggests that tobacco use is an important risk behaviour prevalent among high school students. Given that this population is vulnerable to long-term use, reaching out to them becomes important for early intervention to discourage tobacco use, thereby preventing complications.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Chadda R, Sengupta S. Tobacco use by Indian adolescents. Tob Induc Dis 2002;1:111-9.  Back to cited text no. 1
Global Youth Tobacco Survey. World Health Organization; 2019. Available from: https://www.who.int/tobacco/surveillance/gyts/en/. [Last accessed on 2019 Apr 30].  Back to cited text no. 2
Ibrahim A, Mathew SB, Arekal SS, Kundapur R. A study to assess the awareness of ill effects of tobacco among adolescents and young adults of Mangalore. Nitte Univ J Health Sci 2016;6:21.  Back to cited text no. 3
Nagaland Second Highest Consumer of Tobacco Products in the Country. Eastern Mirror; 2019. Available from: http://www.easternmirrornagaland.com/nagaland-second-highest-consumer-of-tobacco-products-in-the- country/. [Last accessed on 2019 Apr 30].  Back to cited text no. 4
Shrivastava N, Verma N, Dhiraj B, Soni GP. Prevalence of smokeless tobacco use among school going adolescent students of Raipur city Chhattisgarh state, India. Int J Med Sci 2015;3:921-4.  Back to cited text no. 5
Narain R, Sardana S, Gupta S, Sehgal A. Age at initiation & prevalence of tobacco use among school children in Noida, India: A cross-sectional questionnaire based survey. Indian J Med Res 2011;133:300-7.  Back to cited text no. 6
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Hirani DR, Balaramanamma DV. A study on prevalence of tobacco consumption among school students studying from fifth to eighth standards and assessment of their risk behavior by studying their knowledge, attitude, and practices regarding tobacco consumption in Ahmedabad city, Gujarat, India. Int J Med Sci Public Health 2016;5:191-8.  Back to cited text no. 7
Prasanth YM, Megha B. Tobacco use and awareness patterns among students of an Industrial training Institute in Mangalore, South India. Int J Biomed Res 2014;5:368-70. Available from: https://ssjournals.com/index.php/ijbr/article/view/1017 [Last accessed on 2017 Mar 20].  Back to cited text no. 8
Kumar V, Talwar R, Roy N, Raut D, Singh S. Psychosocial determinants of tobacco use among school going adolescents in Delhi, India. J Addict 2014;2014:170941.  Back to cited text no. 9
Imtiaz D, Kandpal SD, Juyal R, Shrotriya VP, Singh AK. A study on prevalence and pattern of smoking among rural population in Dehradun district of Uttarakhand. Natl J Community Med 2014;5:440-3.  Back to cited text no. 10
Mukherjee A, Sinha A, Taraphdar P, Basu G, Chakrabarty D. Tobacco abuse among school going adolescents in a rural area of West Bengal, India. Indian J Public Health 2012;56:286-9.  Back to cited text no. 11
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