Tobacco and alcohol use among youth and children are a part of the spectrum of adverse health behaviours leading to acute and long term health problems. The diverse socio-economic, cultural and political milieu characterizing Indian states presents several challenges in delivery of health care services and organizing preventive programmes. The present report outlines salient findings from a rapidly progressive State of India, viz., Karnataka.

» Materials and Methods

GYTS - Karnataka (GYTS-K) estimated prevalence of tobacco use in 13-15 yr age group in Karnataka during 2003-04 adopting a three stage (area, school level and class level) cluster sample design: Strata 1 included Bangalore and Mysore as metropolis, other urban Karnataka as transitional area and Karnataka rural as remaining areas. Probability proportional to school enrollment size and lottery method was employed to select school and sections in classes respectively. O perational and logistics issues noted during the pilot study (difficulty in comprehending the use of bubble sheets as response sheets, need for use of a local language version of the study instrument) were attended to in the main study.

The survey work was undertaken in the sampled schools from 12 districts of the State. Twenty schools each were randomly selected in the metropolis and other urban area and 40 schools in rural area. A total of 4,110 students participated from amongst 4,708 on roll. The overall response rate was 87.3% (84% to 91%). Key reasons for non-participation were absence due to festivals and fairs, sickness, extra-curricular activities in schools and monsoon rains. The responses were suitably weighted to arrive at final estimates.

» Results

Overall point prevalence of tobacco use among the 13 to 15 yr old was 4.9% and life-time prevalence was 5.1%. Current tobacco use was predominantly a male feature and was nearly four fold greater among males (M: 8% vs F: 2.1%). Smokeless tobacco ( gutkha or pan-masala ) use was greater than smoking variety (5.9% and 4.0%, respectively) amongst males, but similar amongst females (1.4% and 1.3%, respectively). Proportion currently using tobacco was greater in transitional Karnataka (10.1%) than in the metropolis (8.3%) and was twice that of rural (4.7%) population. Across 3 regions, use of smokeless variety predominated and proportions were highest in transitional Karnataka (8.2%) compared to metropolis (6.8%) or rural (3.4%). One third of current tobacco users (30.8%) reported that they had purchased the tobacco product in a store. One-fifth of current users smoked (17.2%) or chewed / applied (18.6%) tobacco at home. The proportion of females using smokeless variety at home was nearly double (28.2% vs 13.1%) than those smoking at home. In the other urban Karnataka areas 42% reported smoking at home.

While 46.9% were exposed to tobacco smoke outside their home, 29.7% were exposed to tobacco smoke within their home. Further, between the two genders and across the three regions, nearly half of the never smokers (43% to 56.7%) were exposed to tobacco smoke outside their home. Eighty three percent of the never smokers favored and recommended for a ban on smoking in public places.