PERCEIVED FACTORS AND EFFECTS OF TOBACCO INTAKE IN THE MIZO YOUTH OF HAULAWNG, LUNGLEI DISTRICT, MIZORAM A THESIS. Submitted to

Transcription

1 PERCEIVED FACTORS AND EFFECTS OF TOBACCO INTAKE IN THE MIZO YOUTH OF HAULAWNG, LUNGLEI DISTRICT, MIZORAM A THESIS Submitted to ASSAM DON BOSCO UNIVERSITY In Partial Fulfillment of the Requirements for MASTER OF SOCIAL WORK (MSW) 2017 By LALNUNNGHETA DU2015MSW0043 Department of Social Work Assam Don Bosco University Sonapur

2 Perceived Factors and Effects of Tobacco I CERTIFICATE This is to certificate that the Thesis Perceived Factors And Effects Of Tobacco Intake In The Mizo Youth Of Haulawng, Lunglei District, Mizoram, submitted by Lalnunngheta, DU2015MSW0043 to the Department of Social Work, Assam Don Bosco University, Tapesia Campus, Sonapur, Assam. During the period of his study in the academic year 2015 to 2017, is a bonafide record of the research work carried out under my supervision and guidance. Dr. Lukose PJ Ms. Ainamlin Dkhar Head of The Department Research Guide Department of Social Work Assistant Professor Assam Don Bosco University Department of Social Work

3 Perceived Factors and Effects of Tobacco II ACKNOWLEDGEMENTS First and foremost I thank Almighty God for all His Blessing and Wisdom. I am completely indebted and thank Ms. Ainamlin Dkhar (Assistant Professor at Assam Don Bosco University) who is my guide for my dissertation for all her guidance, care and support without whose support it would have been impossible to produce my work. I convey my special thanks to the Mizo youth of Haulawng, Lunglei District Mizoram, who participated in my data research process and enrich this research much. I thank them for their kind co-operation. I also thank each and everyone who has in one way or the other helped me with tnis research. I am thankful for their guidance, support and sharing their views which has helped shed new light during the process of this research. Lastly, I would like to show my heartfelt gratitude to my family for their supports and encouragement that have made my dissertation work easier and possible. Date : Place : Guwahati LALNUNNGHETA

4 Perceived Factors and Effects of Tobacco III Dedicated to my beloved Dad & Mom Mr. C. Lawmsanga & Mrs. T. Zoremsiami And Also my beloved Grandma & Siblings

5 Perceived Factors and Effects of Tobacco IV PREFACE Tobacco use in legal use in everywhere in the world, yet it causes far more details than all other psychoactive substances combined. More people die from tobacco related diseases other than cancer such as stroke, myocardial infraction, and peptic ulcer. Young who take up smoking have been shown to experience an early onset of cough, phlegm production, and shortness of breath on exertion. The thesis is on perceived factors and effects of tobacco intake in the Mizo youth of Haulawng, Lunglei District, Mizoram. The researcher has chosen the respondents from the areas of Haulawng, Lunglei District. The respondents are between the age group of 15 years to 30 years and all are from the Mizo community, belonging to Christian. The study has five chapters: Chapter 1 gives the introduction and background of the study. Chapter 2 presents review of literature. Chapter 3 deals with the research methodology which includes:- significance of the study, statement of the problem, research design, research setting, sample size, sources of data, and tools used for data collection. Chapter 4deals with the analysis and interpretation based on collected data. And Chapter 5 deals with the main findings and discussion, suggestions and conclusions of the study. Furthermore, in order to meet the objectives of the study, the researcher was carried out by using questionnaire. A set of questions was given to the respondents that focus the perceived factors and effects of tobacco intake among the Mizo youth Haulawng.

6 Perceived Factors and Effects of Tobacco V TABLE OF CONTENT CERTIFICATE i ACNOKNOWLEDGEMENT ii DEDICATION iii PREFACE iv TABLE OF CONTENT v-viii LIST OF FIGURES ix-x CHAPTER 1 INTRODUCTION 1.1 Introduction Background of the study 2-4 CHAPTER 2 REVIEW OF LITERATURE 2.1 Introduction Effects of tobacco Prevalence of tobacco use in India Tobacco using in Mizo history Tobacco use among the Mizo Tobacco consumption in India 14-16

7 Perceived Factors and Effects of Tobacco VI 2.7 Patterns of tobacco consumption In India Global perspectives of tobacco use Prevalence of different forms of tobacco use Effects of tobacco use on general health Effects of tobacco use on oral health CHAPTER 3 RESEARCH METHODOLOGY 3.1 Introduction Rationale of the study Statement of the problem Operational definition of the key-terms Research question Objectives of the study General objective Specific odjectives Hypothesis Research design Descriptive research Method adopted for the study 25

8 Perceived Factors and Effects of Tobacco VII 3.11 Procedure Sources of data Primary data Secondary data Tools of data collection Questionnaire Population of the study Sampling Sample size Delimitation of the study 28 CHAPTER 4 DATA ANALYSIS AND INTERPRETATION 4.1 Introduction and Figure CHAPTER 5 MAIN FINDINGS AND SUGGESTIONS 5.1 Main findings Demographic profile of the respondent Different types of tobacco products used Consumptions of tobacco Reasons for tobacco usage 62-63

9 Perceived Factors and Effects of Tobacco VIII Effects of health intake tobacco Suggestions CONCLUSION REFERENCES APPENDIX 72-78

10 Perceived Factors and Effects of Tobacco IX LIST OF FIGURES Figure 4.1 Age Of Respondents 30 Figure 4.2 Sex Of Respondents 31 Figure 4.3 Marital Status Of Respondents 32 Figure 4.4 Educational Qualification Of Respondents 33 Figure 4.5 Occupation Of Respondents 34 Figure 4.6 Religion Of Respondents 35 Figure 4.7 Caste Of Respondents 36 Figure 4.8 Domicile Of Respondents 37 Figure 4.9 Socio-economic Status Of Respondents 38 Figure 4.10 Using Tobacco In The Past Two Three Days 39 Figure 4.11 Age Of Initiating/Starting Tobacco Intake 40 Figure 4.12 Types Of Tobacco Intake 41 Figure 4.13 Age Of Respondent First Intake Of Tobacco 42 Figure 4.14 Morning Intake Of Tobacco 43 Figure 4.15 Family History Of Tobacco Intake 44

11 Perceived Factors and Effects of Tobacco X Figure 4.16 Money For Tobacco Intake 45 Figure 4.17 Friends Circle Tobacco Intake 46 Figure 4.18 Knowledge Of Negative Impact Of Tobacco Intake 47 Figure 4.19 Difficulty Face Where It Is Forbidden 48 Figure 4.20 Intake Tobacco When They Are Ill 49 Figure 4.21 Places Of Tobacco Intake 50 Figure 4.22 Duration Of Tobacco Intake 51 Figure 4.23 Reasons For First Intake 52 Figure 4.24 Addictive Tobacco Intake 53 Figure 4.25 Insight Taking Causes Serious Illness 54 Figure 4.26 Knowledge Of Negative Impacts 55 Figure 4.27 Factors That Lead To Intake Tobacco 56 Figure 4.28 Money Spent On Tobacco Intake 57

12 Perceived Factors and Effects of Tobacco Intake 1 CHAPTER 1 INTRODUCTION 1.1 Introduction Tobacco use is one of the man risk factors for a number of chronic diseases, including cancer, lung diseases, and cardiovascular diseases. Despite this, it is common throughout the world. Young people who take up something have shown to experience an early onset of cough, phlegm production, and shortness of breath on exertion. Experimentation with smoking as a symbol of adult behavior is common in adolescence. It is suggested that there factors are associated with young people smoking; peer pressure, following the example of friends, siblings and parents and employment outside the home. Tobacco use is one of the major preventable causes of death and disability worldwide. The emergences of tobacco-related diseases are a growing public health problem. According to recent WHO estimates, 4.9 million deaths annually are attributed to tobacco. Currently, about one-fifth of all worldwide deaths attributed to tobacco, occur in India, where more than 800,000 people die and 12 million people become ill as a result of tobacco use each year. With the current smoking pattern, about 300 million people who are alive today will eventually be killed by tobacco use. Tobacco is a green, leafy plant that is grown in warm climates. After it is picked, it is dried, ground up, and used in different ways. It can be smoked in a cigarette, pipe, or

13 Perceived Factors and Effects of Tobacco Intake 2 cigar. It can be chewed (called smokeless tobacco or chewing tobacco) or sniffed through the nose (called snuff). Nicotine is one of the more than 4,000 chemicals in cigarettes and its smoke. It is the chemical that makes tobacco addictive or habit forming. Once we smoke, chew, or sniff tobacco, nicotine goes into our bloodstream, and our body wants more. The nicotine in tobacco makes it a drug. This means that when we use tobacco, it changes our body in some way. Because nicotine is a stimulant, it speeds up the nervous system, so we feel like we have more energy. It also makes the heart beat fast and raises blood pressure. According to Medical Dictionary, Smoking is the inhalation of the smoke of burning tobacco encased in cigarettes, pipes, and cigars. Casual smoking is the act of smoking only occasionally, usually in a social situation or to relieve stress. A smoking habit is a physical addiction to tobacco products. Many health experts now regard habitual smoking as a psychological addiction, too, and one with serious health consequences. According to Oxford Dictionary, Tobacco refers to the leaves of the tobacco plant that have been dried and processed for people to roll up and smoke. Tobacco is the main ingredient in cigarettes, and of course, chewing tobacco. 1.2 Background of The Study The term Mizo is derived from two Mizo words Mi and Zo. Mi in Mizo means person. There is dispute of the term Zo. According to one view, Zo means highland and Mizo means highlander or people living in high hills. The Mizo people are an ethnic group native to north-eastern India, western Burma (Myanmar) and

14 Perceived Factors and Effects of Tobacco Intake 3 eastern Bangladesh; this term covers several ethnic peoples who speak various Mizo languages. The Mizo are one of the hill tribe (Zo people). Nowadays the Mizo people are mostly 88.00% Christian, following a wide variety of denominations. The clan of Lusei people were the first Mizo people to become known to outside groups; the largest ethnic group was first named after them as the Lushai. The present Indian state of Mizoram (literally Mizoland ) was called the Lushai Hills and was defined as a district of Assam in the British Raj and independent India. The people of the Lushai Hills demanded a distinct political territory when India achieved independence. Due to continuing efforts by its people to gain autonomy, the national government approved Mizoram in1972 as a Union Territory and in 1987 as a fullfledged state of India. Youth is the time of life when one is young, but often means the time between childhood and adulthood (maturity). It is also defined as the appearance, freshness, vigor, spirit, etc.., characteristic of one who is young. Its definitions of a specific age range varies, as youth is not defined chronologically as a stage that can be tied to specific age ranges; nor can its end point be linked to specific activities, such as taking unpaid work or having sexual relations without consent. Youth is an experience that may shape an individual s level of dependency, which can be marked in various ways according to different cultural perspectives. Personal experience is marked by an individual s cultural norms or tradition, while a youth s level of dependency means the extent to which they still rely on their family emotionally and economically.

15 Perceived Factors and Effects of Tobacco Intake 4 Young people is the most vulnerable and more influenced by marketing than adults, they are also more willing to take risks, even with their health, when smoking or smokeless form of tobacco is portrayed as social norms among others who are seen as cool, sophisticated, rebellious or fun-loving, youth often respond by copying the behavior and trying cigarette themselves. If their friends smoke or their siblings smoke, they are even more likely to smoke themselves. It is bad for health and causes many serious diseases later in life. In spite of its bad effects the use of tobacco products is on the increase across the globe. It is observed that tobacco use is highly prevalent among the Mizo youth. Hence the researcher wants to scientifically assess perceived factors and effects of tobacco intake in the Mizo youth of Haulawng. The researcher will conduct the study in Haulawng. Haulawng is located in the Indian state of Mizoram at the Lunglei District. The latitude and longitude of Haulawng is and The population of Haulawng is 2,300 and 552 house. Population by sex is Males 1,226 and Females 1,074 and Youth between age of is 530.

16 Perceived Factors and Effects of Tobacco Intake 5 CHAPTER 2 REVIEW OF LITERATURE 2.1 Introduction In the position of the chapter the researcher has attempt to review books, journals, and internet which are related to the topic of the present study Prevalence of tobacco intake among the Mizo youth Tobacco can be used in various forms; it can be smoked, chewed, sniffed or dipped. In whichever the form it is used, tobacco releases nicotine which is a stimulant that increases activity in the brain just like caffeine, cocaine and amphetamine (Jarvis 2004, Jha et al 2006). The stimulant effect of nicotine to the brain creates the desire for a person to continue using tobacco until one becomes addicted therefore being exposed to harmful effects of other chemicals present in tobacco. Unfortunately, in addition to nicotine other antigenic, cytotoxic, mutagenic and carcinogenic chemicals that are harmful to oral and general health are also released (Behr and Nowak 2002). The release of these harmful chemicals from tobacco may explain why tobacco use has been strongly associated with oral cancer increased susceptibility to periodontal diseases reduced response to periodontal therapies (Tonetti et al 1995) and increased risk of dental implant failure (Bain and Moy 1993). Other adverse effects of tobacco use on oral health include tooth staining and halitosis (Johnson and Bain 2000). On general health, tobacco use especially tobacco smoking has been associated with occurrence of lung cancer and cardiovascular diseases (van der Vliet and Cross 2000, Shammas 2007).

17 Perceived Factors and Effects of Tobacco Intake 6 Tobacco use is on increase in developing and middle income countries (Behr and Nowak 2002, Jha et al 2006). Since tobacco use is a habit that has been shown to start at young age (Watt and Daly 2003, da Silva et al 2006, Kwamanga et al 2003), it is therefore important to ascertain the magnitude of tobacco use and its associated factors and institute appropriate intervention at this young age. The importance of instituting an intervention at this age is three folds. First, it would help those who had not initiated using tobacco to remain non users. Secondly, for those who have started using tobacco would stop the habit before being heavily addicted. Thirdly, those who would quit tobacco use early will have less chance of developing oral cancer and periodontal diseases because studies have shown that the adverse effects of tobacco use on health are dependent on the quantity (amount) consumed and duration of using tobacco products (Weintraub and Burt 1987, Calsina et al 2002). According to the World Health Organization on the Global Tobacco epidemic states that, nearly one-third of adults in the world are smokers. Cigarette consumption per adult has been declining in the developed countries but it rising (from a lower level) in developing countries. Combined with population growth, what the World Health Organization calls the global tobacco epidemic is still expanding space and is increasingly a developing country phenomenon. Its health implications are direct. Tobacco use is recognized as a major risk factor in some cancers and in respiratory and cardiovascular disease making it according to the World Health Organization, the leading preventable cause of death in the world. As of early 2008 countries were parties to World Health Organization s Framework Convention on Tobacco Control,

18 Perceived Factors and Effects of Tobacco Intake 7 committed to imposing limit so in advertising, putting health warnings on cigarette packets and protecting people against exposure to tobacco smoke. Although tobacco rarely make headlines, tobacco kills one person every six seconds. Tobacco kills a third to half of all people who use it, On average 15 years pre maturely. Today, tobacco use causes 1 to 10 deaths among adults worldwide? More than five million people a year by 2030, unless urgent action is taken, tobacco s annual death toll will rise to more than eight million. If current trends continue unchecked, it is estimated that around 500 million people alive today will be killed by tobacco. During this twenty first century, tobacco could kill up to one billion people. Most tobacco users will want to quit but will be unable to because of their dependence on a highly addictive drug nicotine to the brain immediately after smokers inhale about as efficiently as an intravenous injection with a syringe. The tobacco industry itself has referred to cigarettes as a nicotine delivery device. But because the effects of smoked tobacco last only a few minutes, smokers experience withdrawal symptoms unless they continue to smoke. Smokeless tobacco is also highly addictive and causes cancer of the head and neck, esophagus and pancreas, as well as many oral diseases. 2.2 Effects of Tobacco Tobacco use is the leading preventable cause of disease and premature death in the United States, resulting in an estimated 438,000 premature deaths annually, or nearly one of every five deaths each year (Centers for Disease Control and Prevention, 2005). Tobacco use causes more deaths each year than alcohol use, car crashes, suicide, Acquired Immunodeficiency Syndrome (AIDS), homicide, and illegal drug use combined (McGinnis & Foege, 1993). Additionally, smoking accounts for $167

19 Perceived Factors and Effects of Tobacco Intake 8 billion annually in health care expenditures and productivity losses. Health effects of tobacco are the effects that use of tobacco has on human health, and concern about health effects of tobacco has a long history. In 1950, Richard Doll published research in the British Medical Journal showing a close link between smoking and lung cancer. In 1954, the British Doctors Study, a study of some 40,000 doctors over 20 years, confirmed the suggestion based on which the government issued advice that smoking and lung cancer rates were related. Tobacco use is the single greatest cause of preventable death globally. As many as half of people who use tobacco die from the results of this use. The World Health Organization (WHO) estimates that each year tobacco cause about 6 million deaths (about10% of all deaths) with 600,000 of these occurring in non smokers due to secondhand smoke. In the 20 th Century tobacco is estimated to have caused 100 million deaths. Tobacco use leads most commonly to diseases affecting the heart, liver and lungs. Smoking is a major risk factor for heart attacks, strokes, chronic obstructive pulmonary disease (COPD) (including emphysema and chronic bronchitis), and cancer (particularly lung cancer, cancers of the larynx and mouth, and pancreatic cancer). It also causes peripheral vascular disease and hypertension. The effects depend on the number of years that a person smokes and on how much the person smokes. Starting smoking earlier in life and smoking cigarettes higher in tar increases the risk of these diseases. Also, environmental tobacco smoke, or secondhand smoke, has been shown to cause adverse health effects in people of all ages. Tobacco use is a significant factor in miscarriages among pregnant smokers, and it contributes to a number of other health problems of the fetus such as premature birth, low birth

20 Perceived Factors and Effects of Tobacco Intake 9 weight, and increases by 1.4 to 3 times the chance of sudden infant death syndrome (SIDS). Incidence of erectile dysfunction is approximately 85 percent higher in male smokers compared to non-smokers. Several countries have taken measures to control the consumption of tobacco with usage and sales restrictions as well as warning messages printed on packaging. Additionally smoke free laws are useful, do not have negative economic effects for restaurants of bars and help people who smoke to quit. Taxing tobacco products in an effort to increase the price is also effective, especially in developing countries. Tobacco smoke contains more than fifty chemicals that cause cancer. Tobacco also contains nicotine, which is a highly addictive psychoactive drugs. When tobacco is smoked, nicotine causes physical and psychological dependency. Cigarettes sold in underdeveloped countries tend to have higher tar content, and are less likely to be filtered, potentially increasing vulnerability to tobacco smoking related disease in this regions. 2.3 Prevalence of Tobacco Use in India Surveys covering prevalence of tobacco use are rare in India. Information on tobacco use has been provided by the population-based surveys conducted in limited areas to study risk factors for various diseases and mortality. Additionally, two major national surveys have also collected limited tobacco use information. The prevalence and trends of tobacco use will be discussed based on these studies conducted mostly on populations 15 years of age and above.

21 Perceived Factors and Effects of Tobacco Intake 10 In India, the National Sample Survey Organization (NSSO) has been conducting yearly surveys since Tobacco use is part of the consumer behavior component of the National Sample Survey (NSS), conducted every five years. The nationwide survey was undertaken as the 50th round of the National Sample Survey (NSS, ) and a total of 115,354 households located in 6951 villages and 4650 urban blocks were visited and information on tobacco use including product types were obtained for all members aged 10 years and above residing in each surveyed household. This information was obtained from one member of the household, usually the male head. The NSSO tabulated the survey results for urban and rural resident s gender - wise and age wise for 32 states and union territories. In the report the age groupings were as follows: 10-14, 15-29, 30-44, and 60 + years. The NSSO survey showed that 432,393 individuals of all ages were tobacco users. The major findings were 51.3% males and 10.3% of females were regular tobacco users; 35.3% males and 2.6% females were regular smokers; 24.0% males and 8.6% females were regular users of smokeless tobacco and about 250 million users were aged 10 + years in the country. Thus among males smoking remained by far the most common form of tobacco consumption and among females chewing of zarda, dokta, etc. was the most common form of tobacco consumption in most parts of the country. Another nationwide household survey, the National Family Health Survey (NFHS), in its second round ( ), collected information on tobacco use and health-related practices and behaviour in 26 states. Over 90,000 households were surveyed and information on paan/tobacco chewing and tobacco smoking were obtained for 315,597 persons aged 15 years and above. In the NFHS-2 report, the age

22 Perceived Factors and Effects of Tobacco Intake 11 categorization adopted was 15-19, 20-24, 25-29, 30-39, 40-49, and 60 years and above. It found that tobacco use among men was 46.5% and among women 13.8%. The prevalence of smoking and chewing varied widely between different states and had a strong association with individual s socio-cultural characteristics. The survey found that prevalence of both chewing tobacco/pan masala and smoking tobacco was significantly higher in rural, poorer, and uneducated populations compared to urban, wealthier and more educated populations both in men and women, though the differentials for chewing tobacco were smaller. The socioeconomic gradients (by household wealth as well as by education) were steeper for women than for men for both chewing tobacco/pan masala and smoking tobacco. While the two surveys have similar sampling methods, it should be kept in mind that in the National Sample Survey the male head of the household responded for all members, while in the National Family Health Survey the female head of the household responded for all members, which is an important difference in methodology. Prevalence rates of tobacco use were calculated from both the recent NSS 50th Round and NFHS-2 for the population aged 15 years and above to permit comparison 16. Other than the above two nationwide survey reports, the results of a complete rural population survey have also been used to estimate the national prevalence in this section. This survey was conducted in the entire Karunagappally population located in Kollam district of Kerala during These results were also used for estimating prevalence as this was a complete population survey conducted by face-toface interviews with results tabulated for 5-year age groups by gender, which made it possible to obtain age-specific prevalence rates for males and females. In the rural

23 Perceived Factors and Effects of Tobacco Intake 12 Karunagappally population, current tobacco use prevalence in the population 15 years of age and above were 53.8% among males and 14.2% among females. According to a study tobacco use increases with increasing age. It is seen that in areas with a high prevalence of tobacco use, initiation may occur at an early age. The National Household Survey of Drug and Alcohol Abuse in India (NHSDAA), conducted in 2002 among males, covering over 40,000 individuals aged years in nearly 20,000 households in 25 states revealed that the overall prevalence of current tobacco use was 55.8% showing an increase in tobacco use with age, leveling off after 50 years of age. Prevalence studies of tobacco use in India have shown wide variations between urban and rural areas, regions, age, gender, education, and other socio-demographic variables across the country. It is clear that the estimates obtained here suffer from limitations. The most important limitation is that the surveys were not designed to collect information on tobacco use. Surrogate responses were used, which can introduce inaccuracies and biases. Also, the household was used as a sampling unit rather than an individual, and it was not possible to make appropriate statistical adjustments for that while doing the estimation. 2.4 Tobacco Using in Mizo History Both sexes generally smoked tobacco. The men used a pipe called Vaibel which consisted of a bowl made out of a particularly hard kind of bamboo and a small bamboo tube fastened to the bowl. The women had a special form of pipe, miniature hookah about 9 inches with a clay bowl, and the water container was a bamboo tube. The water when thoroughly

24 Perceived Factors and Effects of Tobacco Intake 13 impregnated was transferred to the tuibur gourd. This nicotine water the man took into his mouth from time to time., and having kept it there for a few minutes, he spat it out. It is said that to hold nicotine water in the mouth had a stimulating effect (Lalrimawia, Mizoram History., 1995). 2.5 Tobacco use among the Mizo s The traditional way of initiating smoking habit to young people at the tender age of 13 by the Mizo society, though discontinued since the past few decades. Young boys and girls were introduced to smoking by their parents, as they had to work in the jhums infested by mosquitoes. A number of smoking and smokeless tobacco products are in use all over the world. But unlike other smokeless tobacco products, a unique tobacco smoke infused water is used in the Mizo community and it is locally known as Tuibur. This product is made locally by passing smoke, generated by burning tobacco, through water until the preparation turns cognac in color and has a pungent smell. Tobacco water known as Tuibur is sipped and retained in mouth for 5 to 10 minutes and then spit out, in one sip usually 5 to 10 minutes tobacco water is kept within mouth. It is earlier sipped directly from bottle the and through cotton soaked with tobacco water, one who uses tobacco water to clean one s teeth or to protect from insect bites initially, some start sipping several times a day and get addicted. Common practice is seen. Tobacco use is the part of culture in the Mizo community. Meizial it is a local cigarette made from Vaihlo (Nicotiana dadcum) tobacco. After plucking, the tobacco leaves are thrashed by feet until the leaves become soft and most of the juices flow out. Then they are dried in the sun or sometimes in a warm

25 Perceived Factors and Effects of Tobacco Intake 14 place like over the fireplace without applying direct heat. Then they are cut into small pieces and rolled directly using thin paper. 2.6 Tobacco consumption in India Cigarette consumers are the smallest constituent of adult tobacco users in India. According to the survey of GATS (Global Adult Tobacco Survey) India are 34.6% are all tobacco products of adult users and 5.7% are cigarettes of adult users and smokeless tobacco consumers are 25.9% (including 5% dual user). The small share of Cigarettes in the overall tobacco consumption is a result of high and discriminatory tax policy Cigarettes taxes are 47 times higher than other tobacco products. According to the report of Ministry of Finance, Govt. of India; Industry Estimates are in cigarettes 3419 Tax Rs./kg and in other tobacco products 73 Tax Rs./kg. Non-Cigarette tobacco products consumed in India are Bidis, Cigars, Hookah/Water Pipes, Chuttas, Dhumti, Chillum, Pipes, Cheroots, Betel Quid with Tobacco, Khaini, Gutkha, Paan Masala, Mishri, Mawa, Gul, Bajjar, Gudakhu, Snuff. Bidis Bidi consists of a small amount of tobacco hand wrapped in dried tendu leaf and tied with string. Cigars Cigars are made of air cured and fermented tobaccos with a tobacco leaf wrapper and come in many shape and sizes. Hookah/water Pipes The Hookah also known as Water Pipes, Shisha or Hubble Bubble is a single or multi-stemmed instrument for vaporizing and smoking flavored tobacco in which the tobacco smoke is passed through water before inhalation.

26 Perceived Factors and Effects of Tobacco Intake 15 Chuttas Chuttas are coarsely prepared cheroots. They are usually the products of cottage and small-scale industries, or are made at home. In Chutta and Dhumti smoking the ignited end of its placed inside the mouth. Dhumti Dhumti is a kind of a conical cigar made by rolling tobacco leaf of another plant. Generally dhumti are prepared by the smokers themselves. Chillum The Chillum is a straight, conical pipe made of clay, 10-14cm long, held vertically. Pipes Pipes smoking is the practice of tasting the smoke produced by burning tobacco, in a pipe. Cheroots A cheroots is a roll made from tobacco leaves. Betel Quid with Tobacco The term betel quid for most people is synonymous with pan. The term quid denotes a substance or a mixture of substances made from areca nut and it may contain a variety of ingredients, including betel leaf and tobacco. Khaini Khaini is essentially raw tobacco mixed with exclusive fragnances and spices for achieving desired flavors. Gutkha Gutkha is a preparation of crushed areca nut, tobacco, catechu, paraffin wax, slaked lime and sweet or savory flavorings. Paan Masala Pan Masala is a mixture of betel leaf with lime, areca nut, clove, cardamom, mint, tobacco, essence and other ingredients. Normally consumed in combination with tobacco.

27 Perceived Factors and Effects of Tobacco Intake 16 Mishri Masheri, also called mishri, is made at home by roasting tobacco flakes on a hot metal plate until it burns brown or black. It is applied to gums and teeth and retained in the mouth for variable time period. Mawa This is a combination of areca nut pieces, scented tobacco, and slaked lime that is mixed on the spot and chewed as a quid. Gul Gul is an oral tobacco powder which is rubbed over the gum and teeth. Bajjar Bajjar (dry snuff) is another tobacco product used mainly by women for cleaning teeth and gums. Gudakhu Gudakhu is a paste-like tobacco preparation used widely in Orissa and neighboring states of India. During use it is rubbrd over the teeth and gum with a finger tip. Besides tobacco, it contains molasses, lime, red soil and water. Snuff Snuff is a smokeless tobacco made from ground or pulverized tobacco leaves. It is snuffed into the nasal cavity, delivering a swift hit of nicotine and a lasting flavored scent. List of unbranded tobacco products consumed in India produced in the unorganized sector are Hookah/Water Pipes, Chuttas, Dhumti, Chillum, Betel Quid with Tobacco, Khaini, Mawa, Gul, Bajjar. 2.7 Patterns of Tobacco Consumption in India Within each country there is great variation in the consumption patterns. There has also been a complex interplay of socio cultural factors which influenced not only the acceptance or rejection of tobacco by sections of society but also determined the

28 Perceived Factors and Effects of Tobacco Intake 17 patterns of use. In traditional Indian joint families smoking at home was initially a taboo. It was restricted to only the dominant male members of the family. The younger members of the family would desist from using it in the presence of the elders and even the master of the house would not use it when an elderly relative, especially an aged parent, was around. Members of different generations smoking together, in a home setting, is rare even today though modernity has led to some relaxation of these rules. The increasing replacement of the joint family by nuclear families, especially in the urban setting, has provided a more permissive atmosphere to use tobacco at home. Although smoking tobacco was a taboo in traditional families but smokeless forms of tobacco was widely accepted. Inclusion of tobacco as one of the ingredients of paan highlights the importance of this product and wide social acceptability of tobacco chewing in ancient India. The social acceptance and importance of paan increased further during the mughal era and paan chewing became a widely prevalent form of smokeless tobacco use in India. Women ate paan for cosmetic reasons as chewing it produced a bright red juice that colored their mouth and lips. For each type of tobacco use, a wide range of tobacco products may be available. Some of these products are industrially manufactured on a large scale, some locally on a small scale, some may be prepared by a vendor and some may be prepared by the user himself or herself. Tobacco may be used in raw, processed mixtures and pyrolised forms. The raw forms are generally sun-cured or air-cured, consist of flakes of plain tobacco leaves mixed with other ingredients especially lime, areca nut and / or other condiments. The pyrolised forms (mishri, bajjar, etc.) are used as dentifrice. Oral use of snuff is also practiced in some specific areas. Though tobacco chewing

29 Perceived Factors and Effects of Tobacco Intake 18 was practised for many centuries, commercial production and marketing were upscaled recently with the introduction of gutka. The rate of growth and consumption of gutkka has overtaken that of smoking forms of tobacco. As a result, oral tobacco consumption has opened a new and broader front in the battle between commercial tobacco and public health in India. 2.8 Global perspectives of tobacco use Prevalence of different forms of tobacco use A study on use of smokeless tobacco (dipping tobacco snuff/chewing tobacco) conducted in Manipur India among the years old reported a prevalence of 10.6% in 2001 (WHO/TFI 2003). Among individuals aged more than fifteen years old rural residents in India the prevalence of using smokeless tobacco were 17.5% (Daniel et al 2008). The reported prevalence of tobacco chewing among students in United States and India was 39% and 32.9% respectively (Salehi and Elder 1995, Joshi et al 2010). In Bangladesh the prevalence of tobacco chewing among adults was reported to be 20.6% (Flora et al 2009) Knowledge on adverse effects of tobacco use on general health Several researchers have reported different levels of knowledge on adverse effects of tobacco use on general health which ranged from 46.5% to 98.2% for lung cancer and 49.3% to 94% for heart diseases (Terrades et al 2009, Siahpush et al 2006, Rikard- Bell et al 2003, Jensen and Overgaard 1993). In their study among dental patients who attended 27 dental practices in Northern Ireland, Terrades and colleagues assessed the awareness of patients about the

30 Perceived Factors and Effects of Tobacco Intake 19 consequences of smoking on their general and oral health. The results indicated high knowledge on smoking as cause of lung cancer (98.2%) and heart diseases (92.3%). Similar results were reported by Siahpush et al (2006) whereby the proportion of respondents who were knowledgeable that tobacco smoking could cause lung cancer and heart diseases were 85.8% and 94.4% for United States, 90.9% and 94.8% for Canada, 89.6% and 93.7% for United Kingdom and 88.6% and 94.3% for Australia respectively. Similar survey was conducted by Rikard-Bell et al (2003) in Central Sydney Area Health Service Australia among 1160 participants to assess patient s knowledge on conditions caused by cigarette smoking. The findings showed that majority of respondents correctly indicated that smoking was a risk factor for the development of lung cancer (91.0%) and heart disease (94.0%). Lower levels of knowledge on cigarette smoking as a risk factor of lung cancer (46.5%) and heart diseases (49.3%) respectively were reported among years old school pupils in Denmark Knowledge on adverse effects of tobacco use on oral health Different proportions of respondents have been reported to be knowledgeable on the cigarette smoking as cause of oral cancer and periodontal diseases. Studies conducted among adults in United Kingdom, showed high proportion of participants being knowledgeable on smoking as a cause of oral cancers. The reported proportion were 76% (Warnakulasuriya et al 1999), 84.7% (West et al 2006) and 85.5% (Terrades et al 2009). Elango and colleagues 2009 evaluated the awareness of oral cancer, its risk factors and estimated the prevalence of risk factors in a highrisk semi-urban population in India aged 10 years old or more. Results showed a satisfactory proportion of

31 Perceived Factors and Effects of Tobacco Intake 20 participants (77.0%) who correctly identified the positive association between tobacco smoking and occurrence of oral cancer. Similarly studies conducted in Australia and Kuwait among adult dental patients indicated that 74% and 62.6% respectively were knowledgeable on cigarette smoking as a cause of oral cancer (Rikard-Bell et 2003, Al Shammari et al 2006).

32 Perceived Factors and Effects of Tobacco Intake 21 CHAPTER 3 RESEARCH METHODOLOGY 3.1 Introduction This chapter consists of various methods and methodology applied during the study. Research is the investigation of an idea, subject or topics for a purpose. It enables the researcher to extent knowledge or explore theory. It offers the opportunity to investigate an area of interest from a particular perspective (Clough and Nutbrown, 2010). Social research aims at discovery of few facts (Ravichandran and Nakkiran, 2009). Through the various methods and methodology the researcher aimed to know more about perceived factors and effects of tobacco intake in the Mizo youth of Haulawng. Methodology is the systematic, theoretical analysis of the methods applied to a field of study. According to Kothari (2014), Research methodology is a way to systematically solve a research problem. It may be understood as a science of studying how research is done scientifically. It studies the various steps that are adopted by a researcher in studying the researcher problem along with the logical behind them. Ahuja, (2001) cities that methodology is the producer of research techniques. It is the logic of a paradigm into research language and shows how the society can be explained and studied.

33 Perceived Factors and Effects of Tobacco Intake Rationale of the study Intake of tobacco is serious and can harm nearly every organ of the body. Despite of the harmful effects of tobacco intake, many people especially the youth in Mizoram continue to use tobacco and increasing day by day. This research study try to understand and find out the perceived factors and its effect of tobacco especially on the lives of youths and the way it affects the family and their wellbeing. This research will be useful for the youth to know more about the effects of tobacco and can also give information to their friends and relatives the negative impacts of tobacco intake on their health. Also the youth understand and realized how much they spent money for to buying tobacco products. Lastly, they can realize using tobacco is affecting the health and economic condition gradually. 3.3 Statement of the problem Tobacco use is common among the youth nationwide and it is not limited to cigarettes. Unfortunately, many youth do not realize how addictive nicotine is. Tobacco consumption either smokeless form or as smoking, is reported to be responsible for various non-communicable diseases like cardio vascular disease and cancers. In spite of its bad effects the use of tobacco products is on the increase across the globe. It is observed that tobacco use is highly prevalent among the youth in Haulawng. 3.4 Operational definition of the key-terms Effect: In my study effect can be understood as an outcome of too much tobacco use which leads to health problems and economic conditions.

34 Perceived Factors and Effects of Tobacco Intake 23 Tobacco: Dried leaves of a plant, which can be smoked or chewed or sniff. It can be intoxicated and can be addict that tobacco using. Youth: Youth can be understood as an age where an individual is in its highest state to undergo through all the adventures of life and experiences that can either develop his or her personality or leave a deep impact on one s life based on an individual s experiences. Perceived Factor: The reasons of tobacco intake according to the youth. 3.5 Research Question Why there is an increasing tobacco intake among the youth? What are the main reasons for the youth to use tobacco? How tobacco intake effects the physical health of an individual? 3.6 Objectives of the Study General Objective To study the perceived factors and effects of tobacco intake in the youth of Haulawng, Lunglei District, Mizoram Specific Objectives To study the effects of tobacco in their health To find out the reasons for tobacco usage among Youth To find out the amount spend for tobacco among the Youth

35 Perceived Factors and Effects of Tobacco Intake 24 To find out their understanding about negative effects of tobacco intake on their health 3.7 Hypothesis A hypothesis is an assumption about relations between variables. It is a tentative explanation of the research problem or a guess about the research outcome. According to Theodorson and Theordon (1969), a hypothesis is a tentative statement a relationship between certain facts. Tobacco intake has serious health problems in the youth. Peers influence, urge to experiment leads the youth to tobacco intake. The youth spend a lot of money for tobacco intake. Young female are more likely to use smokeless (chewed) tobacco. The youth has less knowledge and understanding on the negative effects of tobacco intake on their health. 3.8 Research Design According to Kothari (2004) state that a research design is the arrangement of conditions for collection and analysis of data in a manner that aims to combine relevance to the research purpose with economy in producer research design is the logical and systematic planning and directing the research. Research design is needed because it facilities the smooth sailing of the various operations. In other words, a research design is a tentative strategy of research process, which is most likely to be modified by new aspect, new conditions and new interrelations between variables, as it progresses.

36 Perceived Factors and Effects of Tobacco Intake Descriptive Research The researcher used descriptive design for the present study. Descriptive research can be explained as a statement of affairs as they are at present with the researcher having no control over variable. Moreover, descriptive research may be characterized as simply the attempt to determine, describe or identify what is, while analytical research attempts to establish why it is that way or how it came to be. Descriptive research is aimed at casting light on current issues or problems through a process of data collection that enables them to describe the situation more completely than was possible without employing this method Method adopted for the study The researcher on the study perceived factors and effects of tobacco intake among the youth used quantitative method because it is relevant for the research. The researcher study and find out the effects and perceived factors of tobacco intake among the youth in Haulawng and it is concerned with how much? How many? How often? The study will be fruitful with good answers from the youth Procedure The researcher went to the field to meet the respondents for data collection. The researcher choose the respondent purposely from different places like shop, stationary, tailoring and so on. When meeting these respondents, the researcher introduced and explained about his research and distributes the questionnaires to the respondents to fill it up and the researcher collected it back from the respondents.

37 Perceived Factors and Effects of Tobacco Intake Sources of Data There are two main sources of data collection in this study, namely: Primary data : Primary data are first hand information. This information is collected directly from the source by means of field studies. Primary data are original and are like raw materials. The researcher used primary data through questionnaire, observation and interview method. The questionnaires are being set in English and are closed ended question Secondary data : The researcher used secondary data through the reviewing of newspapers, journals and from different website available prior to the research. Secondary sources consist of readily available compendia and already complied statistical statements and reports whose data may used by researchers for their studies (Krishnaswami, 1993) 3.13 Tools of Data Collection There are different methods or tools for data collection. The researcher for the pesent study used the following methods for data collection Questionnaire In tools questionnaire are used for data collection. In questionnaire the researcher used the questionnaires prepared by the researcher and distribute to the respondents in order to collect data.

38 Perceived Factors and Effects of Tobacco Intake 27 Questionnaire enlists questions, which translate the research objectives into specific questions. The questions must also encourage the respondent so that the necessary data is obtained (Das, 2010) Population of the study Population refers to all the people with the characteristics the researchers wants to study within the context of a particular research problem (Ahuja 2012). The population refers to all the people with the characteristics which the researcher wants to study within the context of a particular research problem. Haulawng youth age between both male and female are the main population study of the researcher Sampling A sample is a subset of a population that is used to represent the entire group as a whole. According to Ahuja (2012) a sample is a part of the population which is studied in order to make inferences about the whole population. 60 samples were taken for the study Sample Size Sample size is the number of observations or sampling units selected from the population to include in a statistical sample. The sample for the study is 60 respondents from Haulawng with the age group between years for both male and female.

39 Perceived Factors and Effects of Tobacco Intake Delimitation of the study The delimitation of the study is that the researcher is limited only to the youth of Mizo and limited only to Haulawng, Mizoram and not in other areas. It will also difficult for the researcher to get exact answers regarding his research questions since some of the youth are did not open up to his questions. The study is limited to the knowledge and experience of the researcher in the subject.

40 Perceived Factors and Effects of Tobacco Intake 29 CHAPTER 4 DATA ANALYSIS AND INTERPRETATION Introduction Data analysis is the process of organizing and classifying the information one has collected, tabulating it, analyzing it, comparing the results with other appropriate information and presenting the results in an easily understandable manner. In this chapter the researcher will mainly discuss the analysis and interpretation. The researcher will analyze and interpret the data collected on the perceived factors and effects of tobacco intake in the Mizo youth of Haulawng. The researcher distributed questionnaires in the areas of Haulawng, Lunglei District, Mizoram such as Mizo to both male female. The analysis and interpretation is presented below in different pie charts, according to the objectives of the research study. The data gathered from the sample was first complied and stored in SPSS (Statistical Package for the Social Sciences) program which was then analyzed and interpreted through the process of editing, coding and entry into computer with the application of relevant statistical software. The research has tried presenting each of the essential findings in a sequential order of the research questionnaire.

41 Perceived Factors and Effects of Tobacco Intake 30 Figure 4.1 Ages of Respondents This figure clearly shows that 55 percent of the respondents fall in the category of 21-25, 30 percent of the respondents are fall in the category of 15-20, 15 percent of the respondents fall in the category of Thus it can be clearly stated that majority of the respondents mostly fall in the age category of This age group is considered to be youth who might be literate or illiterate as will see in next demographic data % 30% 55%

42 Perceived Factors and Effects of Tobacco Intake 31 Figure 4.2 Sex Of Respondents This figure shows that majority of the respondents 58 percent are male and rests 42 percent of them are female. Hence, we can say that male constitutes the key population in the study. Male Female 42% 58%

43 Perceived Factors and Effects of Tobacco Intake 32 Figure 4.3 Marital Status Of Respondents This figure shows the marital status of the respondents. The data shows that majority 91 percent of the respondents are unmarried and 5 percent of the respondents are married and 2 percent of the respondents are divorce and others. This indicates that majority of the respondents are unmarried. Married Unmarried Divorce Others 2% 2% 5% 91%

44 Perceived Factors and Effects of Tobacco Intake 33 Figure 4.4 Educational Qualification Of Respondents This figure shows that the 38 percent are passing secondary in the educational qualification of the respondents. 22 percent of the respondents are passing graduate. 16 percent of the respondents are passing high school. 9 percent of the respondents are passing higher secondary. 7 percent of the respondent are passing upper primary. 6 percent of the respondent are passing post graduate and above. 2 percent of the respondent are passing primary. Hence, the majority of the respondents educational qualification are passing Secondary 38 percent. Primary High School Higher Secondary Post Graduate and Above Upper Primary Secondary Graduate 6% 2% 22% 7% 16% 9% 38%

45 Perceived Factors and Effects of Tobacco Intake 34 Figure 4.5 Occupation Of Respondents This figure shows that the respondents occupation 36 percent of the respondents occupation are none of the above because they are youth and they are still study. 25 percent of the respondents occupation are daily laborer. 22 percent of the respondents occupation are private working. 15 percent of the respondents occupation are business. 2 percent of the respondents occupation are Government servant. Hence, the majority of the respondents occupation are 36 percent none of the above rank because they are youth and they are still study. Government Private Daily Labourer Business None of the Above 2% 36% 22% 15% 25%

46 Perceived Factors and Effects of Tobacco Intake 35 Figure 4.6 Religion Of Respondents This figure shows that all the respondents belong to Christianity by religion or by faith. The majority (87%) of Mizos are Christian in various denominations, predominantly Presbyterian. So, the research place of Haulawng village people are also Mizos and they are belongs to Christian. Religion of Respondent Christian 100%

47 Perceived Factors and Effects of Tobacco Intake 36 Figure 4.7 Caste Of Respondents This figure shows that 100 percent of the respondents are in the caste of Scheduled Tribe. The Constitution of India are listed the Mizos are Scheduled Tribe. So, the research place of Haulawng village are also Mizos and they are also belongs to Scheduled Tribe. Caste of Respondent ST 100%

48 Perceived Factors and Effects of Tobacco Intake 37 Figure 4.8 Domicile Of Respondents This figure shows that the hundred percent of the respondents are from rural area. The researcher focused this study in Haulawng village approximately 180 km from the city. Rural 100%

49 Perceived Factors and Effects of Tobacco Intake 38 Figure 4.9 Socio-economic Status Of Respondents This figure shows that the respondents socio-economic status 44 percent are in the middle socio-economic status. 34 percent of the respondents are in the lower socioeconomic status. 22 percent of the respondents are in the upper socio-economic status. Hence, the majority of the socio-economic status of the respondents are 44 percent in middle socio-economic status. Lower Socio Economic Status Upper Socio Economic Status Middle Socio Economic Status 22% 34% 44%

50 Perceived Factors and Effects of Tobacco Intake 39 Figure 4.10 Using Tobacco In The Past Two Three Days This figure shows that 61 percent of the respondents are took tobacco in the past three days and 39 percent of the respondents are not taking tobacco in the past three days. Hence, in the majority can see that 61 percent of the respondents are taking tobacco before in the past three days. Yes No 39% 61%

51 Perceived Factors and Effects of Tobacco Intake 40 Figure 4.11 Age Of Initiating/Starting Tobacco Intake This figure shows that 38 percent of the respondents are became a daily taking tobacco when the age of and percent of the respondents are taking daily tobacco in the age of percent of the respondents are taking tobacco daily in the age of under 15. Hence, the majority of the respondent 38 percent are becoming daily taking tobacco in the age of and Age 15 or under Age16-17 Age Age % 4% 20% 38%

52 Perceived Factors and Effects of Tobacco Intake 41 Figure 4.12 Types Of Tobacco Intake This figure shows that the respondents currently taking tobacco, that is 44 percent cigarettes of tobacco. 38 percent of chew are the respondents currently use. 18 percent of cigar are the respondents currently use. Hence, the majority of the respondents tobacco currently use is cigarettes 44 percent. Cigarettes Cigar Chew 38% 44% 18%

53 Perceived Factors and Effects of Tobacco Intake 42 Figure 4.13 Age Of Respondent on First Intake Of Tobacco This figure shows that the respondent first tried a tobacco product in the age of 18 and percent. 12 percent of the respondents first tried tobacco product in the age of percent of the respondents first tried tobacco product in the age of 15. So, the majority of the respondents first tried a tobacco product in the age of 18 and percent. Age 15 Age 17 Age 18 Age 19 4% 12% 42% 42%

54 Perceived Factors and Effects of Tobacco Intake 43 Figure 4.14 Morning Intake Of Tobacco This figure shows that the respondents 33 percent after 60 minutes they took tobacco products when they wake up. The respondents 22 percent are not taking when they wake up tobacco products. The respondents 18 percent are taking within 5 minutes when they wake up. The respondents 14 percent are taking minutes when they wake up and the respondents 13 percent are taking 5 10 minutes when they wake up. Hence, in the majority the respondents 33 percent are taking tobacco products when they wake up after 60 minutes. Not taking Within 5 minutes 5-30 minutes minutes After 60 minutes 33% 22% 18% 14% 13%

55 Perceived Factors and Effects of Tobacco Intake 44 Figure 4.15 Family History Of Tobacco Intake This figure shows that the respondents home, their parents/guardians are took inside tobacco products 65 percent. And the respondents parents/guardians 35 percent didn t take inside tobacco in their home. Hence, taking tobacco inside home is the majority 65 percent in the respondents home. Yes No 35% 65%

56 Perceived Factors and Effects of Tobacco Intake 45 Figure 4.16 Money For Tobacco Intake This figure shows that the respondents from where they get money to buy tobacco products and the respondents 76 percent took money from their parents to buying tobacco. So, 24 percent of the respondents are got money from their friends to buy tobacco products. Hence, 76 percent of the respondents are got money from their parents to buying tobacco products. Parents Friends 24% 76%

57 Perceived Factors and Effects of Tobacco Intake 46 Figure 4.17 Friends Circle Tobacco Intake This figure shows that 93 percent some of the respondents closest friends are taking tobacco and none of the respondents closest friends 7 percent. Hence, the majority 93 percent of the respondents closest friends are taking tobacco. None Some 7% 93%

58 Perceived Factors and Effects of Tobacco Intake 47 Figure 4.18 Knowledge Of Negative Impact Of Tobacco Intake This figure shows that the respondents 60 percent are taught in school about the dangers of taking tobacco and the respondents 21 percent are not taught in school about the dangers of taking tobacco and the respondents 19 percent are don t sure to taught in school about the dangers of taking tobacco. Hence, from the study the majority of the respondents 60 percent are taught in school about the dangers of taking tobacco. Yes No Don't sure/not sure 19% 21% 60%

59 Perceived Factors and Effects of Tobacco Intake 48 Figure 4.19 Difficulty Face Where It Is Forbidden This figure shows that the respondents 79 percent says that it difficult to refrain from taking tobacco in places where it is forbidden. 21 percent of the respondents are not facing difficulty where it is forbidden. So, the majority 79 percent of the respondents are find it difficult to refrain from taking tobacco in places where it is forbidden. Yes No 21% 79%

60 Perceived Factors and Effects of Tobacco Intake 49 Figure 4.20 Intake Tobacco When They Are Ill This figure shows that the respondents 62 percent are not taking tobacco when they are ill and bed most of the day time. 38 percent of the respondents took tobacco when they are ill and bed most of the day time. So, the majority of 62 percent of the respondents didn t take tobacco during their ill and bed most of the time day. No Yes 38% 62%

61 Perceived Factors and Effects of Tobacco Intake 50 Figure 4.21 Places Of Tobacco Intake This figure shows that the respondents 23 percent are taking tobacco usually in their home and school and their friends home. The respondents 17 percent are taking tobacco usually at social events and the respondents 14 percent are taking tobacco usually in their work. Hence, the majority of the respondents 23 percent are taking tobacco usually in their home and school and their friends home. At home At school At work At friends home At social events 17% 23% 23% 23% 14%

62 Perceived Factors and Effects of Tobacco Intake 51 Figure 4.22 Duration Of Tobacco Intake This figure shows that the respondents 64 percent are taking tobacco less than 3 years. 29 percent of the respondents are taking tobacco 4 7 years. 7 percent of the respondents are taking tobacco 8 11 years. Hence, the majority of the respondent 64 percent are taking tobacco less than 3 years. Less than 3 years 4-7 years 8-11 years 29% 7% 64%

63 Perceived Factors and Effects of Tobacco Intake 52 Figure 4.23 Reasons For First Intake This figure shows that the respondents 65 percent are start taking tobacco from their friends and the respondents 35 percent are start taking tobacco to their willing of one s own free will. Hence, the majority of the respondents 65 percent are start taking tobacco from their friends. Friends Willing of one's own free will 35% 65%

64 Perceived Factors and Effects of Tobacco Intake 53 Figure 4.24 Addictive Tobacco Intake This figure shows that 75 percent of the respondents are says that taking tobacco are addictive. 25 percent of the respondents are says that taking tobacco are not addictive. So, the majority of 75 percent of the respondents are says that taking tobacco are addictive. No Yes 25% 75%

65 Perceived Factors and Effects of Tobacco Intake 54 Figure 4.25 Insight of tobacco intake causing Serious Illness This figure shows that the respondents 54 percent are believe that taking tobacco causes serious illness. The respondents 27 percent are refused to taking that tobacco cause serious illness. The respondents 19 percent are don t know that taking tobacco causes serious illness. Hence, the majority of the respondents 54 percent are believe that taking tobacco causes serious illness. Yes Don't know Refused 27% 19% 54%

66 Perceived Factors and Effects of Tobacco Intake 55 Figure 4.26 Knowledge Of Negative Impacts This figure shows that the respondents 43 percent are effects of their health during their take tobacco. The respondents 29 percent don t know their taking tobacco effects of their health and the respondents 14 percent are not effects and refused of their took tobacco effects of their health. Hence, the majority of the respondents 43 percent are effects of their health during their take tobacco. Yes No Don't know Refused 29% 14% 43% 14%

67 Perceived Factors and Effects of Tobacco Intake 56 Figure 4.27 Factors That Lead To Intake Tobacco This figure shows that the respondents 58 percent are friends influence that lead to taking tobacco. The respondents 26 percent are climatic conditions that lead to taking tobacco products. The respondents 16 percent are relationship problems that lead to taking tobacco. Hence, the majority of the respondents 58 percent are friends influence that lead to taking tobacco products. Climatic Conditions Friends influence Relationship problems 16% 26% 58%

68 Perceived Factors and Effects of Tobacco Intake 57 Figure 4.28 Money Spent On Tobacco Intake This figure shows that the respondents 46 percent are spent money for tobacco monthly between Rs The respondents 23 percent are spent money for tobacco monthly between Rs The respondents 16 percent are spent money for tobacco monthly under Rs. 100 and the respondents 12 percent are spent money for tobacco products monthly between Rs Hence, the majority of the respondents 46 percent are spent money for tobacco products monthly between Rs Chart Title Under Rs. 100 Between Rs Between Rs Between Rs