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ORIGINAL ARTICLE
Year : 2021  |  Volume : 48  |  Issue : 3  |  Page : 186-191

Awareness about cigarette- and tobacco-related legislation among college students of Belagavi City: An interventional study


Department of Public Health, J. N. Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India

Date of Submission30-May-2021
Date of Acceptance21-Jul-2021
Date of Web Publication28-Dec-2021

Correspondence Address:
Dr. Ashwini Narasannavar
Department of Public Health, J. N. Medical College, KLE Academy of Higher Education and Research, Nehrunagar, Belagavi - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.jss_69_21

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  Abstract 


Background: In 2003, the COTPA act was enacted to control and prohibit tobacco use all over India. It has focused on advertisement, prohibition of sale of tobacco products to below 18 years individual, etc., Objective: The objective was to determine the awareness of cigarette and tobacco legislation among college students of Belagavi city. Materials and Methods: A pre-post study was conducted, comprising 101 urban participants and 96 rural participants of average age 17.35 ± 0.657 years in colleges in and around Belagavi taluka. The students were selected randomly. The awareness on COTPA was assessed using a pretested structured questionnaire before and after an educational intervention. Paired t-test was calculated to identify the difference in the pre- and post-test awareness scores. Results: The mean age of the participants was 17.35 ± 0.657 years. The pretest and posttest awareness scores among the urban participants was 8.22 ± 2.982 and 11.80 ± 1.995, respectively. Similarly, the pretest and posttest awareness scores among the rural participants was 10.28 ± 1.845 and 12.67 ± 0.496, respectively. The result showed a significant difference in pre- and post-test scores, indicating increase in awareness of both urban and rural participants after an effective interventional program. Conclusion: The study concludes that the health education had a good impact on awareness on COTPA among all participants.

Keywords: Awareness, cigarette, legislation, tobacco


How to cite this article:
Yadav SK, Narasannavar A, Bhattarai S. Awareness about cigarette- and tobacco-related legislation among college students of Belagavi City: An interventional study. J Sci Soc 2021;48:186-91

How to cite this URL:
Yadav SK, Narasannavar A, Bhattarai S. Awareness about cigarette- and tobacco-related legislation among college students of Belagavi City: An interventional study. J Sci Soc [serial online] 2021 [cited 2022 May 25];48:186-91. Available from: https://www.jscisociety.com/text.asp?2021/48/3/186/333853




  Introduction Top


The use of tobacco is a global epidemic, which leads to death of nearly 5.4 million people annually, and leading to >80% of deaths in the developing world. According to WHO estimation, 1.3 billion are smokers and among them majority are men (1 billion) and from developing countries.[1] Smoking affects most of the organs of the body and also leads to disease and disability.[2]

India caters about 300 million people in extreme poverty, and even national surveys and studies have shown that huge people continue to use tobacco.[3] Further, there is a long history of tobacco use in India among adolescents. However, it is known that majority of tobacco addiction has been initiated during adolescence.[4]

Before the launch of COTPA 2003, there was another act specially formulated by the Andhra Pradesh (AP) government for prohibition of smoking and health protection in 2002. Despite all these, tobacco use is high in the southern states of India.[5] Later in 2003, the COTPA act was enacted to control and prohibit tobacco use all over India. It was enacted to protect the health of the public, especially prohibiting cigarette and other tobacco use in public places such as hospitals and railway waiting rooms. It also has focused on advertisement, prohibition of sale of tobacco products to below 18 years' individuals, etc., It has stated to display banner and boards stating smoke-free zone and ban on smoking in educational institutions.[1] In studies conducted in different countries, the awareness on tobacco-related act ranged between 11.3% and 75%.[6],[7],[8],[9],[10],[11],[12]

After implementation of this act, the percentage of population awareness of COTPA ranged between 16% and 52% in India.[1],[13],[14] A study conducted in Karnataka showed that 46% of population were aware about the provision of health warning on tobacco products.[15]

All educational institutions have displayed no-smoking boards; students are aware about the hazards of tobacco although they are unaware about the law. However, there is no evidence or studies conducted about COTPA among students, where college students are found to be highly involved in cigarette and tobacco use. Hence, the present study was undertaken to (i) determine the awareness of cigarette and tobacco legislation among college students in Belagavi and (ii) assess the impact of health education among college students of Belagavi city.


  Materials and Methods Top


An interventional study was conducted from January 2021 to April 2021 among preuniversity students in and around Belagavi taluka. Ethical approval was obtained from the Ethics Committee of JNMC. Prior permission was taken from respective colleges before data collection. The selected participants were explained about the procedure and objectives of the study. Informed consent was taken from the participants before the data collection. Two colleges from urban and one college from rural areas were selected randomly. Participants from urban (101) and rural (96) were selected through random sampling method. Both male and female students were included in the study. Those who were not willing to give consent and who were absent during health education and posttest were excluded from the study. Sample size for the study was calculated based on the 95% confidence interval using n = z2pq/d2. The final sample size was 208 in each group.

A pretested, self-administered questionnaire was used to collect information on sociodemographic variables such as age, gender, education level, religion and marital status, and about COTPA. Health education on COTPA was imparted through presentation and after some days, the same questionnaire was used to assess their awareness. Data were entered in MS Excel. Analysis was done using SPSS software version 22 (IBM). Rate and proportion were calculated using descriptive statistics. Chi-square test was used to assess the association between the sociodemographic variables and awareness on COTPA. Paired t-test was used for inferential data. P < 0.05 was considered statistically significant.


  Results Top


The total sample was 208, but the data were analyzed for 197 only. Nine participants were lost to follow-up. Out of the 197 participants, 96 were from rural and 101 were from urban colleges.

Majority of the participants were aged 17 years. The mean age of urban and rural participants was 17.31 and 17.39 years, respectively. Majority of the participants, that is, 73 (72.3%) and 61 (63.5%), were male in both urban and rural areas, respectively. Majority of the participants were from 1st year from both urban (i.e. 62.4%) and rural areas (i.e. 60.4%), and 94% were Hindus. All participants were unmarried in both urban and rural areas [Table 1].
Table 1: Sociodemographic characteristics of the participants

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[Table 2] shows awareness on provisions under COTPA among the urban participants. About half of them, that is, 54 (53.5%), were aware about COTPA, which improved to 94 (93.1%) after intervention, and 56 (55.4%) were aware about the provision of pictorial warning on cigarette packets, which increased to 82 (81.2%) after intervention. Majority of the participants, that is, 89 (88.1%), were aware about ban on smoking at public places, which further improved to 98 (97%) after the intervention. The preintervention scores on awareness on penalties for smoking at public places, prohibition of sale of tobacco products within 100 m from educational institutes, about restriction of sale of tobacco products inside the campus, about ban on advertisement of tobacco products, and prohibition of sale of tobacco products to minor were 64 (63.4%), 65 (64.4%), 74 (73.3%), 33 (32.7%), and 21 (20.8%), respectively, which after intervention increased to 92 (91.1%), 88 (87.1%), 77 (76.2%), 63 (62.4%), and 26 (25.7%), respectively.
Table 2: Awareness of Cigarettes and Other Tobacco Products act among participants from urban colleges

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[Table 3] shows awareness on provisions under COTPA among the rural participants. Majority of the participants were aware about COTPA, that is, 76 (79.2%), which increased to 94 (97.9%) after the intervention. Around 70% of the participants opined that sale of tobacco products inside the campus is not allowed, which increased to 92 (95.8%) after the intervention. Few of them, that is, 35 (36.5%), were aware about ban on advertisement of tobacco products, which increased to 87 (90.6%) after the intervention. Similarly, there was an increase in awareness level regarding the provisions of act such as pictorial warning on cigarette packets, ban on smoking at public places, penalties for smoking at public places, and prohibition of sale of tobacco products to minor after the intervention.
Table 3: Awareness of Cigarettes and Other Tobacco Products Act among participants from rural colleges

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[Table 4] shows awareness level among participants in three categories as poor Poor (≤Mean-Standard Deviation [SD]), Average (>Mean-SD to Mean+ SD) and Good (≥Mean + SD). Among the urban participants, before the intervention, the number of participants with poor score was 24 (23.8%), the number of participants with average score was 61 (60.4%), and the number of participants with good score was 16 (15.8%). After the intervention, the number of participants with poor score was 9 (8.9%), the number of participants with average score was 81 (80.2%), and the number of participants with good score was 11 (10.9%). Among the rural participants, before the intervention, the number of participants with poor score was 13 (13.5%), the number of participants with average score was 71 (74%), and the number of participants with good score was 12 (12.5%). After the intervention, the number of participants with poor score was 31 (32.3%) and the number of participants with average score was 65 (67.7%).
Table 4: Assessment of pre- and post-test level of awareness among urban and rural participants

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Comparing pretest scores among the urban and rural participants, the poor and good scores of awareness were more among urban participants, but the average score was more among the rural participants. Similarly, comparing posttest scores among the urban and rural participants, the average and good scores of awareness were more among the urban participants, but poor score was more among the rural participants. It is observed that after the intervention in the urban participants, the average awareness level increased and poor awareness level decreased, which reveals that there is an impact of health education in increasing the awareness. Similarly, in rural area, there was no change found in both groups of participants as the awareness level was same in pre post-test.

[Table 5] shows that among the urban participants, the mean value of awareness of posttest (11.80) was more than the mean value of pretest (8.22). The computed “t” value of 9.504 was more than the table value at 0.05 level of significance. The present study showed a significant difference in pre- and post-test scores, indicating increase in the awareness of urban participants after an effective interventional program.
Table 5: Association between pre- and post-test awareness among urban and rural participants

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Similarly, among the rural participants, the mean value of awareness of posttest (112.67) was more than the mean value of pretest (10.28). The computed “t” value of 12.451 was more than the table value at 0.05 level of significance. The present study showed a significant difference in pre- and post-test scores, indicating increase in the awareness of rural participants after an effective interventional program.

[Table 6] shows that only gender was significantly associated with pretest awareness scores among the urban participants with P = 0.008.
Table 6: Association between sociodemographic information and pretest awareness scores among urban participants

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  Discussion Top


In the present study, the mean age of the total participants was 17.35 ± 0.657 years. A similar study conducted in Kerala also revealed that the mean age of the study participants was 15.4 ± 1.5 years.[4] According to gender distribution, in the present study, 68.1% of the participants were male and only 31.9% of the participants were female. Another study conducted in Kerala included 79% of male and 21% of female participants and their results were similar to those of the present study.[4] Majority of the participants, that is, 186 (94.4%), were Hindus in this study. No studies have been done that include religion.

In the present study, the awareness about COTPA among the urban participants was 53.5% and among the rural participants was 79.2%. This was in contrast to the findings of a cross-sectional study where less than half (45.7%) were aware about COTPA.[14] In the present study, 55.4% and 85.4% of the urban and rural participants, respectively, were aware about pictorial warning on cigarette packets. In contrast to this, a study conducted in Morocco revealed that only 22.4% were aware about health warning on cigarette packets.[10] In the present study, the results showed that the awareness on ban on smoking at public places was 88.1% among the urban participants and 97.9% among the rural participants. A similar study conducted in Odisha revealed that 80% were aware about prohibition of smoking in public places, which was similar to our findings.[13]

In the present study, the results showed that 63.4% and 80.2% of urban and rural participants, respectively, were aware about penalties for smoking at public places. In contrast to this, less than half, that is, 46.2%, were aware about penalty for smoking at public places in a study conducted in Delhi.[1] In the present study, 73.3% of the urban participants and 71.9% of the rural participants were aware about the prohibition of sale of tobacco products inside educational institutions. In contrast to this, a study conducted in Andhra Pradesh, only 18.9% were aware about the prohibition of sale of tobacco products inside educational institutions.[5] In the present study, the awareness on prohibition of sale of tobacco products to minor was 20.8% and 29.2% among urban and rural areas, respectively. In contrast to this, a study at Chennai revealed that 69.3% were aware about this provision.[16]

The present study showed that 32.7% of the urban participants and 36.5% of the rural participants were aware about advertisement ban on tobacco products. However, a community-based study in Haryana revealed that only 7.6% were aware of the same.[17] In the present study, the awareness on prohibition of sale of tobacco products within 100 m from educational institutions were 64.4% among urban participants and 44.8% among rural participants. A study conducted in Mumbai revealed that 76.6% knew about the prohibition of sale of tobacco products within 100 m from educational institutes, which was similar to our findings.[18]

In the present study, rural participants (79.2%) were more aware about COTPA than urban participants (53.5%). The awareness on ban on smoking in public places was high among the rural participants (97.9%) as compared to the urban participants (88.1%). In contrast to this, a study conducted in Morocco showed that urban participants (35.8%) were more aware about the law as compared to rural participants (29.4%).[10] In contrast to this, a study conducted in Mohali showed that the awareness on ban of smoking in public places was high among urban participants (97.3%) as compared to rural participants (78.1%).[18] The present study showed a significant difference in pre- and post-test scores, indicating increase in the awareness of both urban and rural participants after an effective interventional program (P < 0.05). No studies have been carried out to assess the association between pre- and post-test awareness level on COTPA.

Strength and limitations

To the best of our knowledge, no interventional study has been carried out to assess the awareness on COTPA in India. However, the limitation of this study is that the results obtained cannot be generalized among large population as only three colleges were included.


  Conclusion Top


The study concludes that the health education had a good impact on awareness on cigarette- and tobacco-related legislation among urban and rural participants. Health education on COTPA has increased the awareness level from poor to average and was significant with gender among the urban participants. Laws related to the importance of public health such as COTPA and Narcotics should be included in their curriculum.

Acknowledgment

The authors are thankful to all the respondents who participated in the present study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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