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Indian Journal of Community Medicine

Knowledge, Attitude and Practice Regarding Tobacoo Consumption Among the College Students of Bhavnagar City (Gujarat)

Author(s): V. N. Shah, P.B. Verma, C.B. Tripathi

Vol. 30, No. 1 (2005-03 - 2005-03)


The harmful health consequences of smoking have been well reviewed. Each year brings new discoveries of risk from smoking1. There is a substantial drop in number of smokers in US-from a peak of 41% to its current level of about 25%, but in global picture, cigarette production during the past two decades has increased to an average of 2.2% each year indicating that the consumption of cigarettes is increasing in other parts of the world.

In almost all developing countries from which data are available, some 50% or more of adult men are dependent on some form of tobacco use. Data also suggests that cigarette smoking is going up by 3% a year in the developing countries. Smoking is the preferred habit in men. In most groups, less than 5% of women are smokers2. Most smokers begin to smoke by age of 20 years and the prevalence of smoking among people aged 20 to 24 years is best used for surveillance measures of initiation3. So this is the time, we must take concrete steps to prevent the possible future deaths related to the tobacco consumption.

Material and Methods

A total of 594 out of 2193 students of final year in the 10 colleges (26.92%) were studied and 7 were excluded in final analysis. So the data from a total of 585 students were analyzed. It was cross-sectional study so students of the final year of ten college of Bhavnagar city were given the predesigned and pre-tested proforma to collect the information, in their classroom and told not to write their name to avoid and bias.

For the present study some definitions given by W.H.O. like Smoker, which includes daily smokers as well as occasional smokers and Nonsmoker which includes ex-smoker, exoccasional smoker and never-smoker4 were used. Other two terms are, tobacco chewer, who is a person, who at the time of survey taking any smokeless tobacco products (e.g. mava, panmasala gutkha, pan with tobacco, tobacco with lime etc.) either daily or occasionally and taken at least 50 time in his her life time and ex-tobacoo chewer who is a person who was not taking any smokeless products at the time of survey but used to take in past either daily or occasionally and had taken at least 50 times in his/her life time.


Out of 585 students of various colleges, 394 were male and 191 were female. First the knowledge part was analyzed. All the students knew that smoking is injurious to health and cancer is caused by tobacco consumption. 49.54% students knew that other disease like peptic-ulcer, respiratory illness etc. can also be caused by tobacco consumption. In our study, none of the female students ever used any tobacco products. So the prevalence of tobacco consumption is exclusively among male students. 114 (28.9%) male students were taking some form of tobacco products like cigarettes/ bidis or smokeless tobacoo.

Apparently the tobacco consumption seems to be more common in non-medical (29.4%) as compared to medical students (17.6%) but the difference is statically insignificant. (Chi-square is 0.67 and P value >0.05). It is expected that the tobacco consumption should be lower among medical students because of their knowledge, but it is not the case, means the knowledge has not changed the behaviour of the students. Out of 394 male students, 54 (13.70%) were smoker, out of them 23 (5.83%) were daily smoker and 31 (7.86%) were occasional smoker. The highest prevalence rate of smoking was found in life science college i.e. 27.8% and lowest was in pharmacy college i.e. 4.1%.

56 (14.2%) students were using smokeless tobacco product like gutkha, pan with tobacco etc. Out of them, 23 (5.8%) students were smoker as well as tobacco chewier. 464 students were in category of never smoker, 8 students were ex daily smoker, 3 were ex occasional smoker and 2 were ex-tobacco chewier. So total of 477 students were included in non-smoker category. (n=585). The prevalence rate of Alcohol consumption among students was 2.8% i.e. 11 out of 394 male students drink alcohol occasionally. We have observed that all these students (except one) were tobacco users. The prevalence rate of Alcohol consumption among students was 2.7% i.e. 11 out of 394 male students drink alcohol occasionally. We have observed that all these students (except one) were tobacco users.

The most common reason for starting the tobacco consumption was for the sake of adventure (34.2%) followed by tension, (25.4%), peer pressure (15.8%), tobacco advertisement (5.3%), father smoking (4.4%) and 3 (2.6%) by influence of the movies 14 students (12.3%) did not give any reason. The average duration of habit (either smoking or smokeless tobacco) was found to be 46.1% months (3.8 years), while mean number of cigarettes / bidis smoked was found to be 18.1% per week and average frequency of smokeless tobacco consumption was found to be 17.8 times per week.

The most common situation in which frequency of tobacco consumption increased was when they were in groups (54.4%), followed by examination time (32.4%), loneliness (14.9%) and family problems (1.7%). Out of 114 students, 68 students wanted to give up (59.6%), 57 (50.00%) students had tried to give up the habit, and 13 students (11.40%) could succeeded and rest of them failed to do so, but none of them were able to give the reason for the failure. Out of those suceeeded to give up, 11 gave the credit to self-determination, 1 to friends and 1 to his illness.

The health problem ever faced by the students were, repeated mouth ulcers (18 students - 15.78%), repeated cough (11 students- 9.64%), and breathlessness (7 students-6.14%) No complaints observed in 68.42% students.

The most common measure suggested was, tobacco products must be banned from the market (82.2%) followed by health education and public awareness should be raised about the health hazard of tobacco consumption (54.7%) and banning the tobacco advertisement (44.3%).

Table I : Opinion of students regarding measures to control the problem

Steps According to
According to
Never Smoker
According to
Male With
Smoking Habit
Total %
Ban tobacco product 132 280 69 481 (82.22%)
Ban tobacco advertisement 97 120 32 259 (44.27%)
Health education 128 158 34 320 (54.70%)
(n=585*) (*some students gave more than one opinion)


A striking point in our study was that 100% students knew that the tobacco affects the health adversely. All of them knew that cancer is caused by tobacco consumption while some students also knew that even coronary heart disease, respiratory illness, peptic ulcer etc. caused by tobacoo consumption. Overall the prevalence of tobacco consumption seems to be higher among non-medical students compared to medical students, the difference was statistically insignificant. In our study the prevalence rate of tobacco consumption among male medical students was 17.6%, but certain studies showed the prevalence of 2.7%5.

The prevalence rate of tobacco consumption among females was zero. It might be due to our social structure in which female smoking was not acceptable and it is correlated with the morality. Some studies have shown the prevalence rate of smoking among female ranging between 0-5%. We have observed that most students (34.2%) have started the habit for the sake of adventure followed by mental tension (25.4%), peer pressure (15.8%) and tobacco advertisement (5.3%). We could not find any other study pronouncing the reasons for starting the tobacco use.

Regarding the various health problems related to tobacco consumption ever faced by the students, the most common was repeated mouth ulcers (15.9%), followed by repeated attacks of cough (9.6%), breathlessness (6.1%). Certain studies have shown that the incident rate of mouth ulcer is high in India due to use of smokeless tobacco consumption, in usual traditional form (i.e. tobacco with betel nuts). But in our study the health problem of mouth ulcer faced by students is almost same in both groups i.e. the tobacco chewier as well as smokers.

It was also tried to find out any correlation between the tobacco consumption and any other type of addiction viz. Alcohol. There were 11 students, who were using alcohol and all of them barring one were using tobacco in any form. It might be due to the personality of student, so call addiction prone personality.

We asked the opinion of students regarding the various measures to control the problem to tobacco consumption. The most common opinion given by the students was "Banning of tobacco products" (82.2%). Other opinions were "health education and public awareness about the hazard of tobacco consumption" (54.7%), "banning of tobacco advertisement" (44.3%). Government of Maharashtra has banned the production and sale of "Gutkha" and other state governments are also thinking to follow. But banning only one tobaccoproduct will not solve the problem. Legal measures should be supported by public awareness campaign only then it can make a dent in the problem.


  1. Tierney L M, Mcphee S J, Papadaksi M S Current Medical Diagnosis And Treatment Stamford Alange Publication, 1997;5.
  2. Internet Global Tobacco epidemic.
  3. Brownson R C, Ramintop P L, David J R. Chronic disease epidemiology and control, Washington APHA, 1993;206.
  4. Tobacco epidemic, General. WHO., 1998; 76-80.
  5. Tessier J F et al. Smoking habits and attitude of medical students towards smoking and anti-smoking campaign in nine Asian countries. J. Epidemiol, 1992; 21:139-147.

1 - Intern Doctor, Shri M.P. Shah Medical College, Jamnagar.
2 - Department of P&S.M.,
3 - Deptt.of Pharmacology, Govt. Medical College Bhavanagar.

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