Study of knowledge and attitude regarding ill effects of smoking among current male smokers at Cochin, Kerala

How to cite this article:
Kumar SR, Borker S. Study of knowledge and attitude regarding ill effects of smoking among current male smokers at Cochin, Kerala. Ann Trop Med Public Health 2013;6:389-91


How to cite this URL:
Kumar SR, Borker S. Study of knowledge and attitude regarding ill effects of smoking among current male smokers at Cochin, Kerala. Ann Trop Med Public Health [serial online] 2013 [cited 2020 Sep 23];6:389-91. Available from:

Dear Sir,

Smoking tobacco is a single largest cause of death in adults and elderly in India. NFHS-2 data estimates that currently 30% of the population ≥15 years (47% men and 14% of women) either smoked or chewed tobacco, which translates to almost 195 million people (154 million men and 41million women in India). [1] Many educational programs and government undertaken measures have been adopted for smoking cessation in the community.Despitethis, a large proportion of people smoke in India. We read the issue of Indian Journal of Public Health dedicated fully to smoking and tobacco consumption [2] and thought of sharing this study with the journal.

The current cross-sectional study was undertaken, among current male smokers, at Njarackal (a village near Amrita Institute Cochin) with the objective to know about their knowledge regarding harmful effects of smoked forms of tobacco and their attitude regarding the same. Ethical consent was taken from the institutional ethics committee. Data collection was done by 3 rd year medical students of Amrita Institute Cochin.

A current smoker was defined as a person who has smoked at least one smoked form of tobacco (either a cigarette or bidi or cigar) per day for most of the days of the last month (20 days/30 days in the last month). Data collection (June-July, 2010) was done by face-to-face interview using a structured proforma, which was prepared in English translated in Malayalam and then pilot tested. The minimum sample size obtained for the study was 200. Proforma was retranslated in English language. Female smokers were not included in the study. The following demographic variables like age, sex, education, occupation, income, and marital status were studied. As part of the analysis, we asked the number of cigarette/bidi smoked per day, awareness about ill effects of smoking, and awareness about quitting measures. The attitude was assessed by asking awareness of governmental role in smoking cessation campaign, attempts to quit, reason for the failure in quitting, and smoking among other family members. Besides this, the data regarding age of start, reasons for start, and current reason for continuation was also asked. A total of 220 male smokers were interviewed, of which 41.1% belonged to 46-60 years, 33.7% to 31-45 years, 6.9% to <30 years, and 18.3% to >60 years. A total of 96% of the smokers were married and only 4% were unmarried. Among them, 50% smoked in the house. This shows the high prevalence of passive smokers(wives, children, relatives) among the houses of current smokers in the study setting and 71.8% of smokers were 10 th grade passed, whereas 27.2% were educated up to high school and above level. Only 1% was illiterate. It is very difficult to get illiterate people in an educated state like Kerala, even in villages. Of the study subjects, 69.8% of smokers were skilled workers, 21.2% unskilled workers, and 9.4% were clerical workers. Also, 79.7% had an income of below 3,000 Rs.,out of which, 8.9% hadan income of <1000 Rs./month. Therefore, in spite of their poor income, they continued smoking. In addition, 66.8% smoked cigarettes and 13.4% smokedbidi, whereas the rest smoked both. Bidi smoking was more prevalent among the poor social class and 51% smoked since they derive fun from it, 37.5% of smokers told that they get stress relieved, 15% because of peer pressure, 3% because of family problems; 89% said that they are used to smoking as a habit and cannot quit. Also, 62.3% said that the reason for starting smoking was peer pressure. The rest said that work stress, family stress, fun,and the feeling of masculinity after holding a cigarette in hand as the reason to start smoking. Moreover, 69.3% of smokers started smoking at <20 years, 26.7% at 21-30 years, and the rest (4%) at >30 years. Also, 42.6% study subjects were heavy smokers(>10 cigarettes/day), 25.1% were moderate smokers(6-10 cigarettes/day), and the rest(22.3%) were light smokers(1-5 cigarettes/day). There could be an information bias that was minimized by confirming the data with the wife.

A total of 87.6% subjects were aware about the ill effects of smoking. Out of these, 57.7% knew that smoking caused cancers, 22.28% about respiratory problems, and 10.85% about heart problems. Very few knew that smoking was responsible for kidney, peripheral vascular disease (PVD), and gastrointestinal (GIT) problems. In addition, 69.8% knew that quitting measures were available for smoking cessation. Among them, 9.2% were aware of some drugs used, although none had tried them as yet.

Also, 90.9% were aware of some role government played in smoking cessation in the community, either laws or taxes, and65.3% tried to quit smoking but none succeeded. Most of them (60%) tried it due to a health problemand most of them (40%) said that habit factor hampered them from quitting. Also, 68.3% were willing to quit, and 36.1% of the family members also smoked.

[Table 1] shows that there is a statistically significant association between the age of start of smoking and the quantity smoked. The difference was clinically significant.

Table 1: Correlation between the age of smoking start and number of cigarette currently smoked
Click here to view

There is no statistically significant association between the age of start of smoking and education (P = 0.22;d. f = 2; Chi-square = 2.953). The age at the start of smoking depends on various factors like peer pressure, environmental factors, distance of the cigarette shop from the school premises, and parental upbringing.

The following ill effects of tobacco smoking like cancer, respiratory problems, heart, kidney, vascular obstruction, and GIT problems were known to the study population.

Thus, we concluded that 87.6% were aware of the ill effects of smoking and 30.2% had knowledge about the quitting measures. Most of the smokers smoked due to it being a habit and 81.4% of heavy smokers started smoking at a very early age.


Knowledge about ill effects should be given at the school level. Motivation should be done to quit smoking. People should be made aware of quitting measures. Further studies on the same topic need to be done.


Students of Amruta Institute Kochi for data collection.



1. Rani M, Bonu S, Jha P, Nguyen S, Jamjoum L. Tobacco use in India: Prevalence and predictors of smoking and chewing in national cross sectional household survey.Tob Control 2003;12:e4, 1-8.
2. Narain JP, Sinha DN. Tobacco epidemic in South-East Asia region. Indian J Public Health 2011;55:151-240.

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.121024

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