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Cigarettes hanging from a red string.

U researchers have found that sixth-grade students in urban India use tobacco, such as cigarettes, at two to four times the rate that eighth graders do.

Lighting up in India

U study finds children in India are smoking more tobacco at a younger age

March 15, 2006

According to a report by the Ministry of Health and Family Welfare in New Delhi, India, messages in a rapidly changing India may be increasingly pro-tobacco despite policies to control tobacco. These messages, it states, are the result of greater exposure to media from other countries, smoking in Bollywood movies, and images via the Internet.

Is smoking, therefore, on the rise in India?

Recent research by University of Minnesota School of Public Health experts suggests that India could be facing an alarming increase in tobacco use. The study, published in the Feb. 18, 2006, issue of The Lancet, found that sixth-grade students (average age of 11 years old) in Delhi and Chennai used significantly more tobacco than eighth-grade students. Early use of tobacco predicts greater likelihood of addiction, longer lifetime use, and higher rates of lung cancer, state the authors.

"The difference in rates of tobacco use strongly suggests that sixth-grade students in urban India use tobacco at two to four times the rate that eighth graders do," says Cheryl Perry, U professor of epidemiology and coauthor of the study. "These findings warrant confirmation and early intervention in young students."

The researchers also found that male students were more likely to smoke tobacco than female students, and those that attended government schools smoked more than private school students.

Perry and her colleagues surveyed more than 11,600 students in the sixth and eighth grades at 32 schools in Delhi and Chennai about their use of chewing tobacco, cigarettes, and bidis (hand-rolled cigarettes). These schools were selected because they were representative of the range of schools in these urban cities, including government (low-to-middle income), private (middle-to-upper income), girls-only, boys-only, and coeducational schools.

India's tobacco advertising bans

In 2003, India passed the Cigarettes and Other Tobacco Products Act, which prohibits all direct and indirect advertising of tobacco products, smoking in public places, sales of tobacco products to people younger than 18, and sales of tobacco products near educational institutions. Yet in spite of this legislation, the tobacco industry has developed ways around it.

Cheryl Perry and her colleagues offer an example in their recently published study in The Lancet: "One tobacco company (Godfrey-Philips India) positioned air-conditioned lorries ("Mobile Smoking Lounges") outside major attractions, such as a sports stadium and shopping malls, in four major cities in India, including Delhi, so smokers can sit in the lounge and smoke in comfort."

Tobacco use continues to be the leading cause of preventable death worldwide. By 2030, scientists estimate that 10 million people per year will die from tobacco use, with 70 percent of those deaths occurring in developing countries. According to the World Health Organization, India has one of the highest rates of oral cancer in the world, and tobacco-related cancers account for about half of all the cancers among men and one-fourth among women.

In their study, the researchers noted that the epidemic of tobacco use is shifting from developed nations to developing countries, and that it is important to monitor changes in the prevalence of tobacco use among adolescents because increased use may be a precursor to increased rates in the population.

"This pattern was seen very clearly in the USA after the introduction and advertising of brands of cigarettes for women in the late 1960s," the study states. "There were substantially increased initiation rates only among women younger than 18 years old, who remained smokers into adulthood and increased the overall adult female smoking rates in the 1970s and 1980s."

Monika Arora, director of Health Related Information Dissemination Amongst Youth (HRIDAY), says the recent findings "emphasize that intervention programs that aim to prevent and reduce tobacco use among youth should begin before eighth grade (or about age 13)." HRIDAY is a Delhi-based organization that collaborated with the U and the All India Institute of Medical Science on this study.

"Young people need to be motivated to adopt a healthy lifestyle and abstain from addictions such as tobacco right from an early age before these habits get etched," adds Arora. "Factors leading to tobacco use at such a young age need to be clearly identified and countered."