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Indian Journal of Community Medicine

A Study of Tobacco Use Among Street Children of Delhi

Author(s): C Malhotra, R Malhotra, MM Singh, S Garg, GK Ingle

Vol. 32, No. 1 (2007-01 - 2007-03)

Tobacco consumption is a major preventable cause of death, accounting for 13,000 deaths per day globally. Tobacco use often begins before adulthood1. Large number of children in the age group of 13 years to 15 years are currently using or have tried tobacco. Nearly a quarter of these young smokers began before the age of 101. India has one of the highest youth smoking rates in the world1. Amongst children, street children, as a group, are particularly at a higher risk of developing use of tobacco products. This study was conducted to fi nd out the tobacco consumption habits and reasons for initiation and continuation of tobacco use by these children and to assess their awareness about the harmful effects of tobacco use.

Material and Methods

This was a cross-sectional study conducted between January and March 2003 at “Prayas”, a Child Observation Home (COH) for boys in Delhi. The COH houses runaway/ street children, in the age group 6 to 18 years, who are brought by the police, for a maximum period of 3 months. For the purpose of the study, boys aged 10-18 years were interviewed at the time of their entry in the home, using a pre-tested semi-structured schedule. The study protocol was approved by the authorities of child observation home and an informed verbal consent was obtained from the study subjects. A sample size of 60 was calculated on the basis of the results of a pilot study conducted on 20 boys, in which the ever use of tobacco products was found to be 62% taking an allowable error of 20%. Data analysis was done using MS Excel 2000.


A total of sixty boys were interviewed. Ever use of tobacco (used even once) was reported by 34 (56.7%) study subjects. Among these 34 boys, 47.1% were aged 10 to 12 years 79.4%, were Hindu 61.8% had been to school and 79.4% belonged to a united family. Among the 26 children who reported not consuming tobacco, 57.7% were aged 10 to 12 years 57.7% were Hindus 79.9% had been to a school and 88.5% belonged to a united family.

Among those who reported ever use of tobacco, 32.4% had consumed a smokeless form of tobacco, 8.9% had smoked a tobacco product while 58.7% had done both. Out of those children who smoked (n=23), 91.3% smoked bidis, 73.9% smoked cigarettes and 4.3% smoked chillum (fi gures being mutually non-exclusive). Moreover, 65.2% of the smokers smoked the non-ignited end, 13.1 % smoked the ignited end and the rest 21.7% smoked either end of a bidi or cigarette. Of the 18 children who reported having smoked in the last one month, 72.2% smoked daily and the remaining 27.8% smoked 3-4 times in a week. The quantity of bidis/cigarettes smoked in a month by these children was between 1 to 5 by 61.1%, 6 to 10 by 16.7%, 11 to 15 by 5.6% and >16 by 16.7%.

Of the subjects consuming a smokeless form of tobacco (n=31), the most common product consumed was pan masala/gutka (61.3%) followed by pan (51.6%), khaini (38.7%), snuff (16.1%) and others (6.5%). Out of the 24 children consuming a smokeless form of tobacco in last one month, 75.0% consumed daily.

The most common age for initiation of tobacco was between 8 and 10 years with 60.9% of the children smoking and 64.5% consuming a smokeless form of tobacco before 10 years of age. Majority (76.5%) of the children had initiated tobacco use before leaving their house. The most common reason for initiation of tobacco was peer pressure (94.1%) followed by curiosity (17.6%) and pressure by relatives (8.8%). The most common reason for continuation of tobacco use was habit (61.8%), pleasure (38.2%), peer pressure (35.3%), for relaxation (23.5%) and liking of the taste (2.9%). Only 32.4% had attempted to stop tobacco use once or more, since starting and 63.6% among them reported restarting the use of tobacco products, all within a month of leaving.

The reasons for restarting included peer pressure (57.1%), not being able to live without it (42.9%), for pleasure and fun (28.6%) and for relaxation (14.3%). Maximum number of study subjects worked and used their own money for buying tobacco products (88.3%). The rest either used to steal money or tobacco products or beg or borrow money.

Table 1 : Knowledge About Harmful Effects of Tobacco Among Study Subjects.

Consumed Tobacco
Harmful effect *
N= 34
n (%)
N= 26
n (%)
N= 60
n (%)
Lung problems 14 (41.2) 16 (61.6) 30 (50.0)
Cancer 6(17.6) 8(30.8) 14 (23.3)
Discoloration of teeth 5(14.7) 7(26.9) 12 (20.0)
Death 5(14.7) 1(3.8) 6(10.0)
Oral ulcers 4(11.8) 1(3.8) 5(8.3)
Addiction 3(8.8) 1(3.8) 4(6.7)
Pain in stomach 2(5.9) 2(7.7) 4(6.7)
Liver damage 1(2.9) 0(0.0) l (l.7)
Others 5(14.7) 1(3.8) 6(10.0)
Don’t know 10 (29.4) 7(26.9) 17(28.3)
* Figures are not mutually exclusive

Table 1 shows the knowledge about harmful effects of tobacco among study subjects. The most common source of information about harmful effects was parents (34.9%) followed by teacher (27.9%), television, (27.9%), friends (18.6%), radio (16.3%), doctor (14.0%), neighbour (9.3%), sibling (2.3%), police (2.3%), books (2.3%) and poster/banner (2.3%).


The prevalence of ever use of tobacco in the present study was found to be 56.7%. Such high prevalence has been reported from a study conducted on street children in Mumbai2. In the present study, the use of smokeless tobacco was found to be more than smoked tobacco and gutka was the most popular. This conforms to the increasing trend of gutka use in our country2.

In the present study, 58.7% study subjects were consuming both smoked as well as smokeless forms of tobacco. Another study from USA has shown that adolescents who smoke cigarettes are much more likely to have used other tobacco products3.

Majority of the boys in our study had started consuming tobacco before 10 years of age (64.5%). Initiation of tobacco use at 10 years or below was reported by 45.4% boys and 63.8% girls in Bihar2. Research has already shown that early age of initiation of tobacco is associated with a longer duration of consuming tobacco, greater severity of addiction and a lower likelihood of quitting4.

Peer pressure was the most common reason for initiating tobacco use in the current study. Studies have demonstrated that smoking is an acquired, stylized social behaviour. Children aren’t born knowing how to smoke. But when a friend adopts smoking, it becomes a powerful infl uence to smoke5. It has been shown that never smokers whose peers smoke are about twice as likely to initiate smoking over the next year or two5. Since 76.5% had initiated tobacco use before leaving their home, parents can play a role in steering their children away from peers who smoke. Moreover, in the present study, the most common source of knowledge about harmful effects of tobacco consumption was parents (34.9%). It has been shown that parents can decrease the chances that their children will smoke through communication of nonsmoking expectations consistently over time5.

Almost all the boys in our study were purchasing tobacco products, thus showing that these products continue to be widely accessible to minors. Curtailing easy access of children to tobacco is a crucial step in prevention of tobacco use. This requires a more stringent enforcement of “Cigarettes and Other Tobacco Products (Prohibition of advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003” which restricts the sale of tobacco to minors.

Our study does provide an insight into the pattern of tobacco use among the street children of Delhi, but at the same time, considering its sample size of 60 boys and it being conducted on the residents of an observation home, its findings cannot be generalized to all street children of Delhi. Further studies having bigger sample size need to be conducted for elucidating a clearer picture of the pattern of tobacco use among street children.


  1. World Health Organization. Building blocks for tobacco control, a handbook. Geneva; World Health Organization, 2004. p. 4-13.
  2. John S, Vaite S. Tobacco and poverty, observations from India and abroad. Path Canada, 2002. p. 52-60.
  3. Gilpin EA, Pierce JP. Concurrent use of tobacco products by California adolescents. Prev Med 2003; 36(5): 575-584.
  4. Everett SA, Warren CW, Sharp D, Kann L, Husten CG, Crossett LS. Initiation of cigarette smoking and subsequent smoking behaviour among U.S. high school students. Prev Med 1999; 29(5): 327-333.
  5. Sargent JD, DiFranza JR. Tobacco Control for clinicians who treat adolescents. CA Cancer J Clin 2003; 53(2): 102-123.

Department of Community Medicine, Maulana Azad Medical College, New Delhi 110002,
E mail: [email protected]
Received: 25-11-04

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