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Asian Pac J Cancer Prev. 2009;10(5):807-13.

Patterns of tobacco use and psychosocial risk factors among students in 6th through 10th grades in India: 2004-2006.

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University of Texas School of Public Health, Houston, 77030, USA.



In 2004, baseline surveys of Project MYTRI, a randomized intervention trial in Chennai and Delhi, India, found that tobacco use among 6th graders was greater than that among 8th graders. These results were surprising - typically, tobacco use increases with grade level. The present study aimed to assess whether this unique differential was sustained over time, as students moved into higher grades.


Self-reported data from a sample of youth (n=3,404) present at three annual surveys (2004, 2005, 2006) were analyzed. Mixed-effects regression models were used to compare prevalence of lifetime tobacco use and nine psychosocial risk factor scales between two student cohorts, 6th grade (or younger) cohort and 8th grade (or older) cohort. Stratified analyses were also conducted by gender, age, city and school type.


From 2004 to 2006, the 6th grade (or younger) cohort of students reported higher rates of lifetime tobacco use, and these differences were maintained over two years, even when the study sample was stratified by gender, age, city and school type. Similarly, students in the 6th grade (or younger) cohort scored greater risk for tobacco use on all psychosocial risk factors analyzed here.


Tobacco use was found to be problematic among students in two Indian cities, particularly so for those in younger grades. Projections of health impact due to tobacco may be larger than anticipated if these adolescents continue to use tobacco as young adults. Further epidemiologic research and interventions to curb tobacco use among young(er) adolescents are warranted.

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