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Potential Risk Factors of Smokeless Tobacco Consumption Among Adolescents in South India

Kulkarni, Muralidhar M.; Kamath, Veena G.; Kamath, Asha; Lewis, Sarah; Bogdanovica, Ilze; Bains, Manpreet; Cranwell, Jo; Fogarty, Andrew; Arora, Monika; Nazar, Gaurang P.; Ballal, Kirthinath; Naik, Ashwath K.; Bhagawath, Rohith; Britton, John

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Muralidhar M. Kulkarni

Veena G. Kamath

Asha Kamath

Jo Cranwell

Clinical Associate Professor & Reader in Clinical Epidemiology

Monika Arora

Gaurang P. Nazar

Kirthinath Ballal

Ashwath K. Naik

Rohith Bhagawath

John Britton


Introduction: Although most of the disease burden is due to tobacco smoking, smokeless tobacco (SLT) use contributed to an estimated 76,000 deaths in 2017. We have studied the potential risk factors for SLT use among adolescents in South India.

Methods: A cross-sectional questionnaire survey of all students in grades 6 to 8 in schools in the Udupi district of Karnataka State ascertained SLT use status and potential determinants of SLT uptake. Ever SLT use was defined as any reported consumption of any SLT products, currently or at any time in the past. Independent effects on ever-SLT use status were estimated using multiple logistic regression.

Results: Of 46,706 students from 914 participating schools, 39,282 (84.1%) provided questionnaire responses sufficiently complete for analysis. Ever SLT use was reported by 775 (2.0%) participants and in a mutually adjusted model was significantly related to age, male sex, family use or friend’s use of SLT, low socio-economic status, high rebelliousness and low self-esteem. After controlling for these effects, the odds of ever-SLT use were significantly higher among students who had least awareness of the harmful effects of tobacco use [OR 3.7 95% CI (2.9,4.7)] and significantly lower among those not exposed to tobacco advertising [OR 0.7 95% CI (0.5,0.8).

Conclusions: The prevalence of SLT use among children in Karnataka is relatively low as compared to other studies in India. The significant potential risk factors of SLT use include low awareness of the harmful effects of tobacco and tobacco control policies and exposure to tobacco advertising.

Journal Article Type Article
Acceptance Date Dec 22, 2021
Online Publication Date Feb 9, 2022
Publication Date 2022-07
Deposit Date Jan 26, 2022
Publicly Available Date Feb 10, 2023
Journal Nicotine & Tobacco Research
Print ISSN 1462-2203
Electronic ISSN 1469-994X
Publisher Oxford University Press (OUP)
Peer Reviewed Peer Reviewed
Volume 24
Issue 7
Pages 1104-1109
Keywords Public Health, Environmental and Occupational Health
Public URL
Publisher URL


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