A cross-sectional mixed method study to assess the prevalence of tobacco consumption among school going early adolescents of the slum population in Gandhidham, a city in India

One of the most pressing global threats to public health is the use of tobacco, which not only claims lives but also has significant negative social and economic impacts. Over 8 million individuals die globally each year as a result of using tobacco products. Children aged 13–15 years, are currently estimated to consume tobacco with a high rate of 8.4% in India, and 5.4% in the state of Gujarat. Almost half of the adolescents aged 13–15 year who consumed tobacco reported starting tobacco use at around 10 years of age. Preventing tobacco-related mortality is an urgent issue, globally. This study aims to report the prevalence of tobacco consumption (TOCO) among 10–13-year-old school going slum children in the city of Gandhidham, which is the first such study in this population. Our study had a cross-sectional mixed method design and included 404 slum school going Early Adolescents (EAs) representing 3303 slum EAs. The subjects were recruited from 26 schools using multi-stage stratified random sampling technique with three tiers. A validated Global Youth Tobacco Survey (GYTS) questionnaire was used for students along with qualitative interviews of 17 teachers from the same schools between January and July 2024. This study revealed that 19.1% were Ever Tobacco Users (ETUs) while 6.2% were Current Tobacco Users (CTUs). Socio-environmental factors such as TOCO by parents, friends, siblings/cousins, teachers and those who purchased tobacco for family members significantly influence the consumption of tobacco. These findings were corroborated with the results from the qualitative interviews with teachers. The high prevalence of tobacco use, coupled with disturbingly early initiation ages, highlights the importance of the future health of this vulnerable population. The fact that nearly one in five early adolescents has experimented with tobacco, and that initiation often occurs even before the age of 10, calls for a radical rethinking of tobacco prevention strategies. Traditional approaches that target older adolescents may be too late for this population, suggesting the need for prevention efforts to begin in early childhood.