Narotam Sekhsaria Foundation, Mumbai, India.
Nicotine Tob Res. 2020 Oct 29;22(11):2022-2031. doi: 10.1093/ntr/ntaa015.
Tobacco and areca-nut use among adolescents has been reported from different parts of India. Multiple factors influence initiation of tobacco use among adolescents. Initiation of one product gradually extends to multiple products. Studies on initiation lack documentation of the pathways and experiences post-initiation, which is required to holistically understand behavior patterns of adolescents for planning timely intervention. This study was conducted to trace pathways and identify factors influencing the initiation and continuation of tobacco and areca-nut among adolescents.
In this two-staged study, we conducted 14 focus group discussions (FGDs) with 166 adolescents studying in grades 7-9 (11-18 years) from six municipal schools in Mumbai, India. They had self-reported areca-nut or smoked or smokeless tobacco (SLT) use. Pathways of initiation were traced through in-depth interviews for 60 adolescents.
Four multi-linear pathways of use were identified: (1) areca-nut only, (2) areca-nut to tobacco, (3) initiation with SLT, and (4) initiation with smoking. Raw or sweetened areca-nut, betel leaf, gutka, masheri, mawa, hookah, cigarette, bidi, and e-cigarettes were products reported to be used. Curiosity, easy access to tobacco products and normalization of tobacco use influenced initiation. Areca-nut acted as a precursor to tobacco use.
Tracing pathways in tobacco use helped to understand reasons for initiation, influences in continuation of use, and experiences of significance to the adolescents. Experiences of adolescents play a critical role in shaping the pathways of tobacco use. Understanding the pathways and influencers will further help to build effective health promotion communication, policies for sale to minors, and school-based cessation interventions.
Findings of the study provide an insight into unknown areas of information regarding products used by adolescents, their patterns of consumption, perceptions, and their pathways of initiation and continuation of primary and secondary products. This will help in developing specific public health awareness messages, policies regarding packaging and sale of areca-nut to children and interventions targeted for the adolescents and their specific products of use not just in India but for the South-East Asia region as areca-nut and tobacco use among adolescents is common in the region. The exercise of tracing the pathways provides basis for cessation counseling among adolescents.
印度不同地区都有报道称青少年有吸烟和嚼食槟榔的现象。多种因素影响青少年开始使用烟草。一旦开始使用一种产品，就会逐渐延伸到多种产品。关于开始使用的研究缺乏关于启动后途径和体验的记录，这对于全面了解青少年的行为模式以进行及时干预是必要的。本研究旨在追踪途径并确定影响青少年开始和继续使用烟草和槟榔的因素。
在这项两阶段研究中，我们对来自印度孟买六所市立学校的 166 名 7-9 年级（11-18 岁）的青少年进行了 14 次焦点小组讨论（FGD）。他们自我报告有嚼食槟榔或吸烟或无烟烟草（SLT）的使用。对 60 名青少年进行了深入访谈以追踪其开始使用的途径。
确定了四条多线性使用途径：（1）仅嚼食槟榔，（2）嚼食槟榔到吸烟，（3）开始使用 SLT，以及（4）开始吸烟。报告使用的产品包括生槟榔或甜槟榔、槟榔叶、古特卡、马舍里、玛瓦、水烟、香烟、比迪烟和电子烟。好奇心、容易获得烟草产品以及对烟草使用的正常化影响了开始使用。槟榔作为使用烟草的前兆。
追踪烟草使用途径有助于了解开始使用的原因、继续使用的影响以及对青少年有意义的体验。青少年的体验在塑造烟草使用途径方面起着关键作用。了解途径和影响因素将进一步有助于建立有效的健康促进传播、向未成年人销售的政策以及基于学校的戒烟干预措施。
研究结果提供了有关青少年使用的产品、消费模式、看法及其开始使用初级和次级产品以及继续使用的途径和影响的未知领域的信息。这将有助于制定针对特定人群的公共卫生意识信息、有关儿童食用槟榔包装和销售的政策以及针对青少年及其特定使用产品的干预措施，不仅在印度，而且在东南亚地区也很常见。追踪途径的做法为青少年提供了戒烟咨询的基础。
