Ahead of World No-Tobacco Day, rising tobacco use among TN school students raises concerns

There is growing concern over increased instances of tobacco use among school students in Tamil Nadu after a recent study showed that 21 per cent of 300 students surveyed was found to be addicted to tobacco.

A cross-sectional study by the Tamil Nadu Directorate of Public Health and Preventive Medicine conducted among 9th to 12th-grade school students in a Namakkal school reveals that one in five school students use tobacco.

Schools have reported increased incidents of tobacco and tobacco products usage among students. Among the 300 students surveyed, 21 per cent reported tobacco use, with 80 per cent male and 20 per cent female users.

Challenge of substance-abuse

While the study focusses on a school in Namakkal, the officials in the Institute of Mental Health say that the increasing use of tobacco among school-going children is a cause for concern. The school authorities in Chennai and other parts of Tamil Nadu also admit to the increasing challenge of substance abuse in their respective institutions.

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The schools are collaborating with NGOs and government de-addiction centres to conduct community outreach programmes to create awareness. The schools are also trying to address these problems with the help of the families of these children.

76 pc use ‘smokeless tobacco’

Since the prevalence of tobacco usage among school students in India has a range from 1.9 per cent to 75.3 per cent, the prevalence of 21 per cent from a single school in Namakkal is quite high. The study revealed that smokeless tobacco was used by 76 per cent of users, with an average initiation age of 13–15 years.

Cigarette was the second choice with about 19 per cent using it, and the remaining five per cent students use beedis.

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The study published in the Tamil Nadu Journal of Public Health and Medical Research stated that people with early age of tobacco initiation especially school-going children, are highly likely to undergo tobacco-related morbidity and mortality.

As per the current trend, it is estimated around 250 million adolescents, mostly from low to middle-income countries, could face early mortality in the future. In India, nearly 1 in 10 school-going children in the age group 13-15 years has ever smoked cigarettes, the study said.

‘Cool Lip’ product

The study reported that smokeless tobacco being the most common form and 56 per cent of users reported using tobacco more than five times weekly.

The study revealed high prevalence of smokeless tobacco usage among school students, with 76 per cent opting for products like “Cool Lip,” which is particularly concerning. This form is preferred mainly because it can be easily concealed in a school setting and suggests that it is easily accessible and cost-friendly to these school children.

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“Students access the tobacco products from in and around the schools as well. They also observe their parents who consume tobacco and source it from their distributors or get it from their peers,” said Dr Arjuhn R, author of the study.

Multiple types of cancer

Cigarettes and beedis are least-favoured when compared to smokeless-tobacco. Smokeless is notorious in causing a pre-malignant condition called oral submucosal fibrosis in young individuals.

Dr Arjuhn told The Federal that the risk of cancer increases in youngsters, and one can see an onset as early as at the age of 20. There can be lung damage, and multiple types of cancer including lung cancer, head and neck cancer, oral cancer, bladder cancer, and others. Substances such as Cool Lip can lead to inner-cheek skin cancer, since the inner cheek skin is highly-sensitive to carcinogens and can lead to early onset of cancer by five years.

Repeated usage

The study stated that a substantial number of these students engage in regular, repeated use, which may quickly elevate their risk of developing health complications associated with tobacco consumption. The usage of smokeless tobacco was reported to be as early as 4th grade, at the age of 9 years, and the average initiation age between 13 and 15 years.

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The duration of tobacco use was one year in 5 per cent of students, two years in 6 per cent students, and 41 per cent students reported three years of usage, 43 per cent students reported four years of usage, and 5 per cent students had a five-year history. About 16 per cent students reported using tobacco 2-3 times per week, 28 per cent students used it 4-5 times per week, and the majority 56 per cent used it more than five times weekly.

Urgent need for intervention

These usage patterns underscore the urgency for intervention, as early and frequent use during adolescence can lead to stronger addiction and make cessation efforts more challenging in adulthood. All the students were from low to middle-income socio-economic backgrounds.

The study revealed that 80 per cent of students lacked awareness of second-hand smoke dangers, and 64 per cent had family members who smoked.

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"As part of outreach programmes, we have come across school-going children who resort to consumption of tobacco due to peer pressure. The trend is witnessed not just in adolescents but also in young adults. It is not limited to tobacco after a period of time, and they slowly try ganja, tablets, and other drugs," said a psychologist from the Institute of Mental Health.

Targeted educational initiatives addressing tobacco risks, second-hand smoke, and early intervention are essential to curb this growing issue among youth.

Experts emphasised the importance of awareness and monitoring to prevent the rising prevalence of tobacco use.

Effects on mental health

“It is not just physical but even the mental health that gets affected and can lead them towards anti-social behaviour. Moreover, there can be an impact on the overall development and cognitive functioning of these children. It is difficult to de-addict them at a later age as the age of initiation is early. Over the years, these students are at a risk of developing substance abuse and can be fatal,” he added.

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Health experts stated that targeted education on tobacco risks and long-term health impact is essential to address this growing issue. A tobacco user is more likely to use or go on to explore other harmful drugs.

Most vulnerable age groups

Dr Sivram Ganesamoni, senior consultant of surgical oncology at MGM Healthcare, says that more than 88 per cent of all tobacco usage occurs by 18 years of age and 99 per cent by 26 years of age.

These are the most vulnerable populations for getting exposed to tobacco and at this age, they are most vulnerable to getting addicted and making it a habit because the adolescent brain is still developing. That is why it is likely to be more receptive to and susceptible to nicotine than an adult brain.

So, most young smokers go on to become adult smokers and most of them die early, he said.

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“After one year of smoking, the risk of heart disease goes up to almost half of that of a regular smoker. Only after 15 years of quitting smoking, the heart risk comes lower down. Smoking six to ten cigarettes per month has much higher risk for causing cancer and cardiovascular disease,” added Dr Ganesamoni.