title: Tobacco use in Kerala: findings from three recent studies.
abstract: BACKGROUND
  We reviewed the literature on tobacco use in Kerala and present data from three recently conducted unpublished studies.
  
  
  METHODS
  Three cross-sectional studies were conducted; a community-based study of 1,298 individuals aged 15 years and above (mean age 37.4 years, men 630), a school-based study of 1,323 boys (mean age 14.7 years), and a college-based study of 1,254 male students (mean age 18.2 years). Information on tobacco use and sociodemographic variables was collected using pre-tested, structured interview schedules and questionnaires.
  
  
  RESULTS
  In the community study, 72% of men and 6% of women had ever used tobacco. Compared to men with > 12 years of schooling, those with < 5 years of schooling were 7 times more likely to smoke (OR 7, CI 3.2-15.6). The age at initiation of smoking was 19 years among those < 25 years of age compared to 25.5 years among ever smokers > 44 years. In the school study, the age at initiation among boys aged < or = 1 3 years was 10.7 years compared with 13.2 years among > or = 16-year-old boys. Boys whose fathers and friends used tobacco were 2 times and 2.9 times more likely to use tobacco (OR 2.0, CI 1.3-3.1 and OR 2.9, CI 1.6-5.1), respectively, compared with their counterparts. In the college study, 29% of the commerce students used tobacco compared with 5.3% of polytechnic students (p < 0.001).
  
  
  CONCLUSIONS
  Survey data suggest that the age at initiation of tobacco use appears to be falling. A series of cross-sectional studies with larger sample sizes of the youth is required to confirm this impression. Tobacco use habits of fathers and peers are significant influences on youth smoking. There is a need to focus on particular types of colleges as these appear to have high-risk tobacco use environments.
authors.affiliation: Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram 695011, Kerala, India.
authors.forename: A S
authors.initials: AS
authors.lastname: Pradeepkumar
authors.forename: Sailesh
authors.initials: S
authors.lastname: Mohan
authors.forename: P
authors.initials: P
authors.lastname: Gopalakrishnan
authors.forename: P Sankara
authors.initials: PS
authors.lastname: Sarma
authors.forename: K R
authors.initials: KR
authors.lastname: Thankappan
authors.forename: Mark
authors.initials: M
authors.lastname: Nichter
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D006306:Health Surveys; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000453:epidemiology*; D013334:Students; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000453:epidemiology*; D014495:Universities