Research Paper


E-ISSN No : 2454-9916 | Volume: 3 | Issue: 5 | May 2017


Mr. Firoz Qureshi’ | Dr. Nageshwar. V~

‘M.Sc Nursing, Teerthanker Mahaveer College Of Nursing, TMU, Moradabad U.P. * PG- Tutor, Teerthanker Mahaveer College of Nursing, TMU Moradabad, U.P.


INTRODUCTION: In 2004 World health organization, projected (58.8) million deaths globally, out of which (5.4) million were Tobacco - attributed; (4.9) million in 2007 whereas 70% of this in 2002 in developing countries like India only. GLOBAL YOUTH TOBACCO SURVEY (GYTS 2006) reported a prevalence of 13.7 % of tobacco user among school going youth of age group in between 13 to 15 yrs. whereas, in(GYTS 2009), the prevalence these consumptions were 14.6% among youths of 13—15 years. A recent survey conducted in LUCKNOW, by the Union Ministry of Health And Family Welfare, emphasized a 7% rise in the prevalence of male Tobacco use in Uttar Pradesh, on the basis of which health survey committee confirmed that 13% of the U.P population are smokers. METHODS: An electronic search of 50 published articles were started on PubMed, EBSCO, BMC Public Health, Sage journal. Out of which 38 articles were removed and 12 full text articles were selected on the bases of inclusive criteria of narrative review. RESULT: All these studies were successful in exploring adolescent's awareness of substances and associated harm to health from their use of tobacco. “65% of all men use some different forms of tobacco 35% use tobacco by smoking, were 22% use tobacco by smokeless tobacco and 8% both. The age of participants ranged from 12 to 18 years old. Participants were school students. Most important factors seem to be peer influence, parental attitudes, easy access to tobacco and symptoms of dependence. CONCLUSION: Based on all these studies which included in this narrative review, the people who uses tobacco facing major challenges in their entire life. Hence, findings suggests that multifactorial prevention programs that address social norms, gender role, image religion, family, school and incorporated drug policy would be more effective and would have better protective outcomes.

KEY WORDS: “Tobacco, Adolescents”.


Tobacco is the leaf of a plant found commonly in Asia and Brazil. It is usually used in its dry form. Regular use of tobacco not only affects the dental health, but also the rest of the body. Tobacco in different forms is used by people all over the world. Consumption of tobacco is a complex, multidimensional problem faced by the country. The production, sale, and use of chewed and smoke form of tobacco in India have increased, particularly during the past two to three decades. There is no stigma but in fact positive sanction for the use of chewed tobacco. It is popular among men and women and even used by children.

Tobacco use is a leading cause of the preventable deaths and diseases, world-

wide. According to worldwide tobacco use is claiming the lives of nearly 6 mil-

lion people a year worldwide, including more than 600,000 nonsmokers who die

from exposure to tobacco smoke. The first tobacco manufacture in India Gujrat

of Sixteenth Century, Tobacco manufacture can scarcely have started in India dur- ing Akbar's Regin. Gujarat, UP, Karnataka, Andhra Pradesh, over 90% of the

total Tobacco production in the country.

Tobacco use among adolescents in India is a matter of concern. The Global Youth Tobacco survey (GYTS 2006) reported a prevalence of 13.7 % of ever use of tobacco among school going youth in the age of 13 to 15 yrs. And, Global Youth Tobacco Survey (GYTS 2009), the prevalence of consumption of, Tobacco and smoking was reported to be 14.6% and 12.5%, respectively, among the 13—15 year age groups.

LUCKNOW: In a recent survey conducted by the union ministry of health and family welfare, 1t was found that there has been a 7% rise in the prevalence of male Tobacco in Uttar Pradesh. The health survey also confirmed that 13% of the UP population are a smoker with most of them located in Sitapur district where every third man is asmoker. While in chewing tobacco, Banda is the leader where around 67 % men consume Tobacco, In addition, the aim, scope and need of the study, Assessing participants' awareness of types of available substance in their community, route of administration, means of obtaining substance and conse- quences of their use on health. Exploring their views on factors related to sub- stance use among adolescent. Recommending effective prevention strategies tar- geting adolescents in schools and communities.

Aim: The aim of this review is to identify how, where, when use of tobacco among adolescent.

OBJECTIVES: To explore the use of Tobacco among adolescent.


2.1. Search Strategy methods:

An electronic search of articles published in various journals publication period of 2002 2016 was conducted. The papers which were in the English language only. The database search done was PubMed, EBSCO, BMC Public Health, Sage

journal. Articles containing following key search terms were retrieved.

2.1.1 Types of Interventions:

¢ Tobacco, Adolescents, Smoking, Health literacy, Health Promotion, Tobacco Packaging, Health Warnings, Hookah, Narghile, Shisha, Water Pipe, Substance use, Alcohol, Drugs, Perceptions, Floating population.

2.1.2 Types of Studies:

¢ Qualitative Descriptive Study, Focus Group Discussions (FGDs), Snowball- ing Technique, Conventional Content Analysis, Phenomenological Study, Qualitative Content Analysis of the Interviews, Purposive Sampling, Non- probability purposive sampling.

2.1.3 Type of Participants: ¢ Tobacco consumption among adolescent, female non-smokers and occa- sional, Early school leavers.

2.1.4 Settings: ¢ Schools, college, Informal community venues, residing, drivers.

2.1.5 Outcomes: ¢ Decrease the prevalence rate of tobacco consumption among adolescent.

2.1.6 Delivery of Interventions

This narrative review was intended to explore the use of tobacco among adoles- cent. The initial workout starts with the qualitative research review literature. The qualitative studies are suitable to explore feelings, thought, beliefs, idea per- ceived and provide life experience. A literature review was searched from the database search done was PubMed, EBSCO, BMC Public Health, Sage journal, using key words such as tobacco and adolescent. These studies are focusing from 2002-2016. Around 50 articles are investigating the use of tobacco among ado- lescent, from which 12 article excluded (not full text article), again 26 Full text article excluded, with reason. Remaining studies quantitative and some study's not support to my study, so around 50 article, Out of which 38 articles were removed and 12 full text articles were selected on the bases of inclusive criteria of narrative review.

All studies collected the data through the in-depth interview or semi-structured

interviews either face to face interviews with used a audio tape recorder. In con-

ducting the interviews they are using the open ended questionnaires. The dura-

tion of the interviews, mostly taken 5 to 20 minutes of each member, each study.

The majority of studies conducted the interviews with the maintenance of confi-

dentiality and privacy. Non-probability purposive sampling techniques are used

in most of the studies. After data collection, most of the study's data should be ana- lyzed by the thematic analysis. All the studies were ethically approved.

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E-ISSN No : 2454-9916 | Volume: 3 |

3. RESULTS: 3.1. PRISMA FLOW CHART 8 Record identified through data base Additional record identified g searching. through other sources. A (n=50) (n=0) Record after duplicates removed z (n=50) = re 4 A

Record screened Record excluded (not full text article) =5 (n=12)

Full text articles assess for Full text article excluded, with eligibility criteria. reason. Remaining studies (n = 38) quantitative and some study’s not support to my study (n=26) Studies included qualitative synthesis.

(n =12)

(Meta-Analysis was not done)

3.2. Table no.1: Data Extraction table

Issue: 5 | May 2017

Problem Statement/ Objective Place Of Variables Tools Time Outcomes Remark Author Research & Duration Year

study was successful the

“Adolescents' perception} To gainadeeper | Abu Dhabi, Perception of | Focus groups | 10 to 15 | Perception of of substance use Understanding of UAE substance use min. the substance And factors influencing | _ the attitudes and 2015 And factors use associated its use: a qualitative perceptions of influencing its a harm and Study in Abu Dhabi” adolescents use: factors. In the United Arab Layla Alhyas. et al. Emirates regarding substance. “A qualitative study of |-A study of smoking} Shanghai, Study of Focus groups | 10 to 15 | behavior of smoking behavior behavior among China smoking min. Smoking among The floating The floating 2014 behavior among among population in Shanghai, population. The floating floating China” population population Ji-Wei Wang, et all.

“The Role of Family on -A Family on Tehran, Iran |Hookah Smoking} Interview 10 min. Hookah

Hookah Smoking Hookah Smoking Initiation in Each Smoking Initiation in Women: | Initiation in Women. Women member. Family on A Qualitative Study” Initiation in

Women Azam Baheiraei, Shirin

Shahbazi Sighaldeh,

“Motivations for -To determine the | Saudi Arabia Tobacco Discussion 5 to 10 |Motivations for tobacco consumption motivations 20 11 consumption min. tobacco among adolescents in an} (attitudes, beliefs among consumption urban high school” | and experiences) for adolescents among tobacco adolescents Pérez-Milena A, et al. | consumption among adolescents.

“An exploratory study -To explore the Scotland, |Perceived impact} Qualitative | 15 min. | Perceived the of the perceived impact | perceived impact 2009 of Cigarette interviews | For each impact of of raising” among a group. purchase on member. | raising the age

exploring of adolescents and Awareness about substances, associated harm to Health.

This study is a Smoking cessation behavior of male floating population of China's would need to incorporate Comprehensive information and education about why smoking is dangerous.

Prevention of tobacco use and Interventions should be focused on targeting the family.

This study is most important factors seem to be easy available, same age group, religion and parental attitudes, to tobacco and symptoms of dependence.

The study was an exploratory about the extent and nature of the impact of

young Problem Statement/ Objective Place Of Variables Tools Time Outcomes Remark Author Research & Duration Year “age of cigarette -Scottish 16- and smokers in cigarette raising the age of sale on purchase on young 17-year-old school Scotland purchase on young smokers' access smokers in Scotland” | leavers of the recent young smokers cigarettes to ability to increase in age of purchase Borland T; et al. sale of cigarettes. an a ae a a ea oe

International Education & Research Journal [[ERJ]

Research Research Paper

-To explore patterns} US, 2007 of tobacco uptake stress and

trajectories of use.

“Reconsidering stress and smoking: a qualitative study among College students”

Mark Nichter, Mimi Nichter,

Cuba and Mexico, 2013

-Identify prevalence of tobacco and

“Tobacco and alcohol consumption among health sciences students | alcohol use in health in Cuba and Mexico” | sciences students in

Mexico and Cuba. Fabelo JR, Iglesias S,

“Asthma, tobacco

-To identify the Moradabad, prominent factors | (UP) India,

Reconsidering Semi stress and smoking

Alcohol consumption self- min. among health

sciences students | questionnaire

Tobacco use in adolescent students

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When is a feeling stressed than used to smoking and get a relax, serves as an the idiom of distress as well as an opportunity to bond socially with Another.

-students of highlights multiple responses functions Served by smoking,

15 to 20 structured min. interviews

10 to 15 | Tobacco and | use in Mexican students, was alcohol seventy percent classified as consumption at-risk users in Mexican among health students of Prevalence sciences alcohol and seventy four students percent, Prevalence of alcohol use in Cuban students was with three and half

percent classified as at risk.



Make a one Policies to reduce

Favored the

-Asthma is common] USA, 2014 | Tobacco smoke | Focus groups | 15 to 20 IC] smoke and the indoor |in homeless children and the indoor min. Each] staff smoking |the environmental exposures, environment: a with an incidence of environment member ban on the like ban smoking, qualitative study of 28-40%. shelter property sheltered homeless families” Buu MC, et al.

Structured | 05 to 10 | By the use of | Parental counseling, School questionnaires |min. Each} tobacco parents} based educational programs, member | isinfluence | to regulate the influence use adolescents and| tobacco on their children and they perceived | these programs to protect positive adolescents from being behavior about | exposed to others of tobacco tobacco. use.

Problem Objective Place Of Statement/Author

Research &

-To explore perceptions of 2016

“Adolescent girls and young adult women's perceptions of super- super-slims slims cigarette packaging, packaging: a qualitative | including compact study” ‘lipstick’ packs.

Ford A, Moodie C

“Smoking Initiation and Continuation A Qualitative Study among Bruneian Male

-A study on Brunei smoking initiation | Darussalam, and continuation 2016 among adolescent

Adolescents” male. use

Perception of | Focus groups substance use

And factors influencing its

Determinants of | Focus groups eae to a Adolescent- tobacco-related oriented and health literacy determinants of| literacy have a separate early insight on the | adolescents' and descriptions health literacy. according to recognized

Talip T, Kifli N,

-To Determinants of| South of tobacco-related Finland, health literacy. 2016

“Determinants of tobacco-related health literacy: A qualitative

study with early


“Factors attributing to

initiation of tobacco use

in adolescent students” | leading to initiation 2009 of tobacco use

Ravishankar T L, among adolescents

Nagarajappa R. of Moradabad.

: Parisod H, Axelin A

3.3. Summary of findings:

The available literature refined to get 12 qualitative article.

Out of 12 articles, 6 articles are supported Comprehensive education and infor- mation about why smoking is dangerous and the benefits of stopping tobacco use, focused on targeting the family to prevention and interventions should be as well. Most important factors seem to be, parental attitudes, peer influence, easy access to tobacco and symptoms of dependence.

Other 6 articles were successful in exploring adolescent's awareness of sub- stances and associated harm to health from their use of tobacco in any form.


This narrative review of the literatures observed that student who are using a tobacco in different forms like smokeless form of tobacco and smoking forms of tobacco is used by people. All over the world consumption of tobacco is a com- plex multidimensional problem faced by the country. According to Global Adult

International Education & Research Journal [IERJ]

Variables Tools Time Duration Year

's | Focus groups pee to ia perceptions of increase appeal |'lipstick'-style, cigarette packs super-slims of super slims | and it's a Warnings in the EU cigarette to mislead with level of harm,

Scotland, UK,| Adult women's

cigarette packaging

Outcomes Remark

Found that -This study provide ban

The study three themes identified under the core construct of 1- overt pressure activities from peers, 2- factors

should be influencing smoking embedded in a | initiation, family as teachers

Recommended that prevention of the future

comprehensive | and 3-perceived smoking has

approach, many advantages stakeholders involving all within a community

The study was determinants that influence on health

According to based findings based

Tobacco Survey (GATS) survey, 56% males consume Tobacco in Uttar Pradesh and 34 % men chew Tobacco in different forms like plain Tobacco, khaini, gutkha, pan masala while 22 % use cigarettes, hookah, chilam and bidis. Most people start smoking when they are in their teens and are addicted by the time they reach adulthood. Some have tried to quit but have returned to cigarettes because smoking is such a strong addiction. It is a habit that is very difficult to break.

The results of this narrative review are some parts are similar to one of the other review i.e. “association between smokeless tobacco use and pancreatic adenocarcinoma” Possible risk factor for developing pancreatic adenocarcinoma by the Smokeless tobacco. Is there an association between smokeless tobacco use and pancreatic adenocarcinoma diagnosis? A review of lit- erature” (D Matthew. Burkey, Shari Feirman et, al 2014). This systematic review observed that. Based on this review, found that the evidence for an association between smokeless tobacco use and pancreatic adenocarcinoma is inconclusive. Association between smokeless tobacco use and pancreatic adenocarcinoma,

E-ISSN No : 2454-9916 | Volume: 3 | Issue: 5 | May 2017

were not able to analyze the results in a way that may have produced a more definitive picture of the

Future studies would get the benefit from more detailed assessments of smoke- less tobacco exposure like frequency, intensity, and timing in relationship to pan- creatic adenocarcinoma diagnosis, given strong confounding effect in the rela- tionship between smokeless tobacco use and pancreatic adenocarcinoma. Understanding the health effects of smokeless tobacco will help determine how it should be regulated, and how governments should respond to the increase in smokeless tobacco use.

4.1 Importance in Education:-

Based on all these studies which included in this narrative review, the people who uses tobacco facing major challenges in their entire life. Hence, findings sug- gests that multifactorial prevention programs that address social norms, image religion, school and gender role family incorporated drug policy would be more effective and would have better protective outcomes. Educate the adolescent about use of tobacco complication, suggestion to quit as soon as possible and safe life.

4.2 Future Significance:-

How to Peer group influences on adolescent smoking, there are some theoretical explanations for how social influence works? To what extent does peer smoking predict adolescent smoking? Are adolescents influenced by their friends (social- ization) or do adolescents select friends with similar interests (selection) with respect to smoking? Are close friends, best friends, or crowd affiliations more important? Do positive parenting behaviors buffer the effects of peer influence?

4.3 Limitations:- This study had certain limitations too. This literature review was limited to ¢ Only five databases were used to carry out this literature review.

¢ Thesearch that was carried out within a publication period of 2002-2016. ¢ The papers which were in the English language only. e Articles included were required to be free and in full text.


Use of tobacco is prevalent in adolescent. The factors contributing to the use of tobacco are easy availability, peer influence and after the use of tobacco they are feeling relax.


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2. Baheiraei, A., Sighaldeh, S. S., Ebadi, A., Kelishadi, R., & Majdzadeh, R. (2015). The role of family on hookah smoking initiation in women: a qualitative study. Global jour- nal of health science, 7(5), 1.


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