Prevalence and patterns of use of smokeless tobacco in Mumbai schools

Background Smokeless tobacco use among children is a serious problem in India. Smokeless tobacco products like gutkha, khaini, mawa and misheri and surrogate products like 'supari', 'pan masala' are commonly used by children in Mumbai. Maharashtra state government has banned the manufacture, storage, and sale of such products in the state. Salaam Bombay Foundation conducted a survey in 2014 in Mumbai schools to study the prevalence and patterns of use of tobacco products among children. Methods A cross-sectional survey was conducted among 1558 students of 7 th , 8 th and 9 th grades in 50 randomly selected government schools. Students were asked about smokeless tobacco use, perceptions of harm associated with these products and family use of tobacco products. The results were analyzed using SPSS. Results Mava 2.8% (n=44) was the most commonly reported form of smokeless tobacco ever used by students followed by mishri 2.2% (n=34), gutkha 1.9% (n=30) and khaini 1.2% (n=19). Male students were more likely to report both current and ever use of smokeless tobacco compared to female students (p=0.03). (71.9%, n=1120) students reported gutkha harmful to health. Students who used smokeless tobacco were significantly less likely to believe that smokeless tobacco are harmful (p=0.01). Students who used surrogate tobacco products (supari, pan masala) were more likely to report using smokeless tobacco products than their peers (supari: OR=0.2,95%CI=0.1-0.3) pan masala (OR=0.07,95%CI=0.04-0.09). Students whose fathers used gutkha were more likely to report using gutkha (OR=2.8,95% CI=1.2-6.2) compared to their peers. Conclusions Despite the ban, gutkha continues to be used by students in Mumbai schools along with other smokeless tobacco products like mava, mishri and khaini. Proposed efforts to enforce the ban and increase health warnings on tobacco packages in India should be supported to boost awareness of the health effects of these related products. School-based programs targeting kids should consider involving parents in campaigns