ISSN : 0301-1216

Indian J. Prev. Soc. Med. Vol. 41 No.3 and 4, 2010

A STUDY OF TOBACCO CONSUMPTION
AMONG COLLEGE STUDENTS OF UNIVERSITY OF DELHI, INDIA
Raj Kumar, Alka S, Khushwah MA, Suraj Prakash, VK Vijayan
ABSTRACT
Aims: To determine the prevalence of tobacco consumption among the college students of University of Delhi.
Materials and methods: It was a questionnaire-based study using the survey method of research. 3800 questionnaires were
distributed among the students of University of Delhi. Results: 2599 students (68.4%) returned the completed questionnaire. Of
these, 1635 were males (62.9%) and 964 (37.1%) were females. 422 students (16.2%) were found to be tobacco users. There
were 384 (23.5%) males and 38 (3.9%) female tobacco users. 257 (60.9%) students started tobacco use at the age of 16-20 years.
Cigarette (97.6%) was the most common tobacco product used by the majority of college students. 69.7% used tobacco for fun
and pleasure and 23.2% students used tobacco due to peer pressure. 58.5% of tobacco users were low spenders i.e. expenditure
on tobacco was not more than Rupees 20 per day. Previous history of quitting was present in 47.6% of tobacco users and 54%
tobacco users were willing to quit tobacco use. Family history of tobacco use was present in 57.1% of tobacco users and 37.5% of
non-tobacco users. Awareness about health hazards among students was very high (97.4%) and 95.4% of students were also
aware the benefits of quitting. Conclusion: The prevalence of smoking among students of University of Delhi is 23.57% in males
and 3.9% in females.

Keywords: Smoking Habits, Tobacco Consumption, University of Delhi

INTRODUCTION
Consumption of tobacco was an entertainment at Moghul period in India. But now it is the headache for civilized
society, as the consumption of tobacco is an important cause of many serious diseases. Tobacco consumption is the primary
cause of preventable morbidity and mortality in developed countries1. It has been estimated that there are 1.1 billion tobacco
1-4

users worldwide and 182 million (16.6%) of them live in India . Among them, 80 million are bidi smokers, 40 million are
cigarette smokers and 60 million use chewable forms of tobacco. The highest incidence of oral cancers in the world is reported
5

from India due to high prevalence of consumption of tobacco in chewable forms . Considering the social and the economic
6

impact of tobacco consumption, the cessation interventions are among the most cost effective of all medical interventions . It
has been predicted by the World Health Organization (WHO) that more than 500 million people alive today will be killed by
tobacco by 2030 as the consumption of tobacco will be the single leading cause of death7.
The International Classification of Disease (ICD-10) has recognized that Tobacco Dependence is a disease8. The
medical profession especially in underdeveloped countries has not taken a serious view of the disease of tobacco
dependence, and has not made any serious attempt to treat the disease, Tobacco Dependence 9. One third of the global
population of tobacco user has the median age of 15 years 5. Among this population around 73% live in the developing
5

countries . It has been observed recently that the prevalence of smoking is declining in developed countries due to massive
health awareness campaigns organized by the governments and the control on tobacco sales

10

__________________________
Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi- 110 007
Postal Address: Dr. Raj Kumar, Q. No. 6, Patel Chest Flats, Maurice Nagar, University of Delhi Campus ,Delhi-110007, India
Indexed in : Index Medicus (IMSEAR), INSDOC, NCI Current Content, Database of Alcohol & Drug Abuse, National Database in TB &
Allied Diseases, IndMED, Entered in WHO CD ROM for South East Asia.

Raj Kumar et al

Tobacco consumption in India

From a survey conducted on the students of University of Delhi, India, It has been observed that 83% of male and
87% of female students started tobacco consumption for fun and pleasure and 94 to 98% of students were aware of the
harmful effects of tobacco consumption, the benefit of quitting and the ban of spitting and smoking in public places9. Studies
have demonstrated that a brief physician-delivered intervention (as brief as three minutes) for smoking cessation in primary
care setting significantly increases patients smoking cessation rate 11.
Tobacco users are keen to quit the use of tobacco but they fail in their attempts. They start their habit initially for fun
or pleasure or due to the peer pressure but when they are keen to quit due to some physical or social hazards, it becomes too
difficult. Social support and medication are most essential for tobacco cessation among the users interested to quit.
In most of cases, the consumption of tobacco started at the time of pre or post adult hood period, between 13 -25
12

years. There is enough evidence to show that a majority of tobacco users start their tobacco use before the age of 18 years .
So if the initiative to spread the message of harmful effects of tobacco consumption be taken in the primary school level, the
initiation of the habit can be prevented. Few initiatives have been taken by different national and international agencies to
study the prevalence of tobacco use among the youth. Among these agencies, the Global Youth Tobacco Survey (GYTS) is
13

perhaps the largest programme . College students constitute one of the most vulnerable groups for initiation of smoking. The
exact prevalence of tobacco consumption in this group in India is not known. A study was therefore planned to know the
prevalence of tobacco consumption in college students of Delhi.

MATERIALS AND METHODS:

A questionnaire having the questions about personal profile, tobacco use, reason for starting use of tobacco, family
history of tobacco use etc was designed for this study. Questionnaire also featured the Fagerstrm test to know the Nicotine
Dependence level of subjects.
The survey was conducted for a period of three years. Three colleges namely, Hindu college, Kirorimal college which
are degree college and Law faculty of University of Delhi were selected randomly. Total number of students enrolled in these
three colleges was 5900. Permission was taken from the college authorities for the survey and consent was taken from each
student for the study. Students were assured that the information provided by them will be kept confidential and will only be
used for research purpose. Forty-two classes were randomly selected from these three colleges and all the students of the
selected classes were given the questionnaires to be filled up. A total of 3800 questionnaires were distributed in the colleges.
Students were instructed not to mention their telephone numbers and home addresses in the questionnaire. This
encouraged the students to provide correct data without having the fear of being exposed about tobacco use to parents and
peers. However, they were instructed to mention their classes and sections to avoid the repetition of the data from the same
students. All students were requested to be honest about the information, not to imitate others and not to show their filled up
questionnaire to others. The questionnaire was collected in class room. The data was analysed using SPSS Software
package.

RESULTS
Of the total number of 3800 questionnaires distributed to the students, 2599 (68.4%) returned the completed
questionnaire. The age range of the students was 17 to 32 years. The maximum numbers of students were from the age group
of 17-20 years (54.0%), followed by the age group of 21-24 years, (33.7%), 25-28 years (10.5%) and 28-32 years (1.8%). Of
the 2599 students, 1635 (62.9%) were males and 964 (37.1%) were females and a total of 422 (16.3%) students were tobacco
users. 384 (23.5%) were males and 38 (3.9%) were females (Table 1).

Indian J. Prev. Soc. Med Vol. 41 No.3 & 4

199

July December, 2010

Raj Kumar et al

Tobacco consumption in India

412 (97.6%) were smokers and 10

Table- 1: Status of tobacco use

(2.4%) were using smokeless forms of tobacco.

257 (60.9%) students started using tobacco at

Males
(n=1635)

Status

the age of 16-20 years and 20.1% at 21-25 yrs,

15.4% at 11-15 yrs, 2.2% below 10 yrs and
1.4% > 25 yrs. Most (66.4%) of

Tobacco Users

Females
(n=964)

No.

No.

384

23.5

38

1251

76.5

926

Total
(n=2599)

No.

3.9

422

16.2

96.1

2177

83.8

the students

had been using tobacco for 1-5 years.

Non Tobacco Users

Cigarette (97.6 %) was the most common tobacco product used, followed by bidi (4.8%), Cigar (1.9%), chewing
tobacco (15.4%) and others (0.5%). The total percentage is more than 100 % due to the multiple uses of tobacco products.
Majority (69.7%) of students used tobacco for fun and pleasure and 23.2% students used tobacco due to peer pressure 22
(5.2%) students used tobacco due to film and advertisement exposures, 8 (1.9%) due to sibling and parental influence, 39
(18.8%) due to depression and stress and 4 (1.9%) started tobacco use due to poor academic performance. 57.1% tobacco
users had one or more members in the family who used tobacco.
Out of total number of tobacco users, 130

Table 2: Reasons for willingness to quit

(30.8%) were interested to quit due to the awareness

Particulars

No.

Reasons

228

54.0

(10.9%) due to social problem and 19 (4.5%) due to

Awareness of harmful effects of tobacco

93

40.8

other problems (Table 2). Awareness of the harmful

Health problems

43

18.8

effects of tobacco was the most common reason for

Physical problems

33

14.5

Social problems

33

14.5

Others

26

11.4

of harmful effects of tobacco, 80 (18.9%) due to health

problem, 61 (14.5%) due to physical problem, 46

willingness to quit the use of tobacco. 228 (54%)

students were willing to quit the use of tobacco.

Most of the students (58.5%) were low spenders, i.e. spending only twenty rupees or less per day, 35.6% spend 2150 rupees per day and 5.9% spend more than 50 rupees per day.

DISCUSSION
14

Prevalence of smoking in college students in the US is reported to be 28.5% . It has been observed from our study
that, the overall prevalence of tobacco use among college students of University of Delhi is, 16.3%, (23.5% males and 3.9%
females).Prevalence of smoking among college students in our survey is lower when compared with the prevalence of
general population in India, (45.0% males and 7.0% females). The lower prevalence of tobacco consumption among the
college students may be due to the fact that, they are educated group compared to the entire population. It has been
demonstrated in many studies that there is an inverse relation between education and smoking prevalence

10, 15-18

A study from India among medical students had shown that, the overall prevalence of smoking was 7.04%19. Tobacco
consumption by medical students in the study was low compared to that of other colleges and this observation points to the
fact that, as the medical students are well aware of health hazards of tobacco use, they are less likely to consume tobacco.
Similar results have been seen in the United States (US)

14

, where prevalence of smoking is substantially low in medical

school graduates compared to college students. Another study

20

found the prevalence of smoking in medical school graduates

in US at 2%, which is the lowest reported prevalence in literature, indicating that medical professionals are aware of the
hazards of tobacco use 21.

Indian J. Prev. Soc. Med Vol. 41 No.3 & 4

200

July December, 2010

Raj Kumar et al

Tobacco consumption in India

According to the World Health Organization, most of the students start their first use of tobacco before graduation,
beginning from high school years

22.

In our study, most of the students (60.9%) started their first tobacco use in the adolescent

age. This finding of our study is similar to that of the study reported by World Health Organization. 15.4% of tobacco users
started their first tobacco use between the age group of 11-15 yrs when they are still in the school. In this study the most
important reasons for use of tobacco are fun and pleasure (69.7%) followed by peer pressure (23.2%) a finding similar to an
earlier study

22.

This suggests that fun and pleasure, peer pressure, psychological stresses are the main causes of the starting

of tobacco use.
Cigarette (97.6%) was the most favorable tobacco product used by the students, and bidi (4.8%) was the least form
of tobacco consumed. This may be due to glamour associated with cigarette smoking. The tobacco products used by other
students were the chewing tobacco (Gutkha, Khaini, Pan, etc) 57.1% of students have a family history of tobacco consumption
points to the fact that, students were influenced by family members to start his/her habit of tobacco consumption.
Awareness of harmful effects of tobacco is the most common reason for the willingness of students to quit the use of
tobacco. This emphasizes the fact that, awareness about the harmful effects of tobacco does motivate the smokers to quit.
This has been proved in many developed nations, where massive public awareness campaigns have resulted in decline in
tobacco consumption

23, 24

. These facts must be taken into account by developing countries, which should continue to focus on

public awareness measures. It is also found that females are less prone to the use of tobacco compared to male students. The
consumption of tobacco use among female students may be due to limited opportunities, social tradition, and social restriction.
As the prevalence of smoking habits of medical students has been reported to be 7.04%

14

, it can be presumed from the

results of our study that the general college students are more prone to tobacco use compared to medical students. The
findings from this study support that, educating people about harmful effects of tobacco can be helpful to enhance the quit
rates in the society.
Portrayal of smoking as a glamorous activity by the tobacco industry is an important factor for the use of tobacco use
at early age by the college students. The increasing prevalence of tobacco consumption in women, especially in urban areas,
may be due to the changing social attitudes and westernized lifestyle. Urban women are also being targeted by the tobacco
industry through introduction of so called milder brands of cigarettes combined with glossy advertising campaigns, which are
aimed at making cigarette socially acceptable among women. We need to de-glamorize the image of tobacco through massive
public awareness campaigns to change this mindset. Given the fact that 73% of smokers are in developing countries 4, these
countries need to take urgent steps to curb the growing menace of tobacco. The situation is not that bad when we see that,
54% of smokers in our survey are willing to quit. In this context social support (the family, friend and peer support) and the
medical intervention support (psychological and pharmacological intervention) are needed to help them to quit tobacco. If the
intervention and awareness programme are provided in very early age, then the tobacco consumption and the tobacco related
disease can be minimized. Educated people can influence the common people. Therefore college students should be
motivated to spread the anti tobacco awareness programme. The Government of India has taken steps to eradicate the evil of
25

tobacco consumption and the laws should be strongly enforced by the concerned agencies . We should also seriously
consider introducing a separate subject on health at the school level to educate children about harmful effects of tobacco.
These measures along with legislative control will go a long way in creating a tobacco free society.
Acknowledgement: We authors are thankful to Ministry of Health and Family Welfare, India, and World Health Organization
(WHO) for their financial assistance to conduct this study.

Indian J. Prev. Soc. Med Vol. 41 No.3 & 4

201

July December, 2010

Raj Kumar et al

Tobacco consumption in India

REFERENCES
1.

World Health Organization. Tobacco or Health: A Global Status Report. Geneva: World Health Organization; 1997.

2.

Gajalkshmi CK, Jha P, Ranson MK, Nguyen SN. Global patterns of smoking attributable mortality. In: Jha P, Chaloupka
F. editors. Tobacco Control in Developing Countries. Oxford: Oxford University Press; 2000; Pp.11-39.

3.

Jha P, Ranson MK, Nguyen SN, Yach. Estimates of global and regional smoking prevalence in 1995 by age and sex. Am
J Public Health, 2002; 92: 1002-6.

4.

Shimkhada R, Peabody JW. Tobacco control in India.Bull WHO, 2003; 81: 48-52.

5.

Indian Council of Medical Research (India), Data 2000.

6.

Fiore MC, Jorenby DE. Smoking status as a new vital sign: effects on assessment and intervention in patient who smoke.
Mayo Clin. Proc., 1995; 70 (3): 209-13.

7.

World Bank. Curbing the Epidemic; Government and the Economics of Tobacco Control. Geneva: World Bank; 1999.

8.

World Health Organization. International Statistical Classification of Disease and Related Health Problems; 10
Geneva: World Health Organization; 1994.

9.

Vijayan, VK, Kumar, Raj. Tobacco Cessation in India. Indian Journal of Chest Dis. & Allied Science, 2005; 47: 5-8.

th

(Edn).

10. Pierce JP. International comparisons of trends in cigarette smoking prevalence. American Journal of Public Health, 1989;
79: 152-57.
11. Fiore MC, Bailey WC, Cohen SJ, Dorfman SF, Goldstein MG, Gritz FR. Smoking Cessation. Clinical Practice Guidance
No.18, AHCPR Publication No. 96-0692. Rockville, MD: US Department of Health and Human Service, Public Health
Service, Agency for Health care Policy and Research, 1996.
12. US Department of Health & Human Services. Preventing tobacco use among young people. A report of the Surgeon
general, 1994. Atlanta, Georgia: Public Health Service, Centre for Disease Control & Prevention. Office on Smoking on
Health, 1994.
13. The Global Youth Tobacco Survey Collaborative Group. Tobacco use among youth: a cross country comparison. Tobacco
Control, 2002; 11: 252-70.
14. Henry Weschler et al. Increased levels of cigarette use among college students. JAMA, 1998; 280: 1673-78.
15. Jenkins CNH, Dai PX., Ngoc DN Kinh HV, Hoang TT, Bales S Stewart S, Macphee SJ. Tobacco use in Vietnam.
Prevalence, predictors, and the role of the transnational tobacco corporations. JAMA, 1997; 277: 1726-31.
16. Venket Narayan KM, Chadha SL, Hanson RL, Tondon R, Shekhawat S, Fernandes R, Gopinath N. Prevalence and
patterns of smoking in Delhi: cross sectional Study. BMJ, 1996; 312: 1576-79.
17. Gong VL, Kaplan JP, Feng W, Chen CN, Zheng P, Harris JR. Cigarette smoking in China- prevalence, characteristics,
and attitudes in Minhang Dstrict. JAMA, 1995; 274:1232-34.
18. Anjum Memon, Moody P, Sugathan J, Mal-Bustan Nal - Jazzaf. Epidemiology of smoking among Kuwaiti adults:
prevalence, characteristics, and attitudes. Bulletin of World Health Organization, 2000; 78: 1306-15.
19. Behera D, Malik, SK. Smoking habits of undergraduate medical students. Indian J Chest Dis & Allied Sciences, 1987; 29:
182-84.
20. Richard S Mangus et al. Tobacco and alcohol use among 1996 Medical school graduates. JAMA, 1998; 280: 1192-93.
21. Baldwin DC, Hughes PH, Gonard SE, Storr CL, Sheehan DV. Substance use among senior medical students: a survey
of 23 medical schools. JAMA; 1991; 265: 2074-78.
22. World Health Organization. Reducing the glamorization of tobacco movies on theatre and in music videos. Tobacco Free
Initiative, 12th September, 2002; Pp-1-6.
23. Garfinkel L. Trends in cigarette smoking in the US. Prev. Med, 1997; 26: 447-50.
24. World Bank. Curbing the epidemic. Governments and the economics of tobacco control. Washington DC: World Bank,
1999. www.globalink.org/tobacco/wb/ (accessed 2 Feb 2000).
25. Ministry of Health & Family Welfare, Govt. of India. Report on Tobacco Control in India. Reddy KS & Gupta PC (Eds),
2004.

--Indian J. Prev. Soc. Med Vol. 41 No.3 & 4

202

July December, 2010