Prevalence & correlates of tobacco use among adolescents in Kerala, India.

BACKGROUND & OBJECTIVES: Most tobacco users who initiate its use during adolescence are likely to continue the use into adulthood and contribute to the 90 per cent of premature deaths among tobacco users. In this context the prevalence, patterns and correlates of tobacco use were studied among adolescent school students in Kerala, India. METHODS: Total 7560 students from classes 8, 10 and 12, within the age group of 12-19 yr, across 73 schools in Ernakulam district, Kerala, India, selected by cluster random sampling, completed a self-administered questionnaire incorporating standardized instruments. RESULTS: Of the 7350 valid questionnaires, the overall lifetime prevalence of tobacco use was 6.9 per cent (12.5% males and 1.2% females). The prevalence of tobacco use increased from 3.1 per cent at 12-13 yr to 15.1 per cent at 18-19 yr. The mean age of onset of tobacco use was 14.0±2.2 yr. The prevalence was higher among students from urban backgrounds, lower socio-economic status and those with part-time jobs. Tobacco users had significantly higher rates of use of alcohol (67.8 vs. 11%) and illicit drugs (33 vs. 6.1%). They had poorer academic performance (24.7 vs. 9.1%), more severe psychological distress (10.8 vs. 4.5%), suicidal attempts (10.2 vs. 3.5%), higher scores of ratings of attention deficit hyperactivity disorder (8.3 vs. 2.5%) and history of sexual abuse (12.5 vs. 3.8%). INTERPRETATION & CONCLUSIONS: The prevalence of tobacco use in adolescents reported in this study was relatively lower than those reported from other Indian States. However, it correlates with multiple negative outcomes suggesting a need to promote specific interventions to prevent adolescent tobacco use.

An epidemological study of obsessive compulsive disorder in adolescents from India.

OBJECTIVES: There is scarce data on the prevalence of OCD among adolescents in India. This study reports point prevalence of OCD among school students (age 12-18years) in the Kerala state of India and examines its association with ADHD, psychological distress, tobacco/alcohol abuse, suicide risk and history of sexual abuse. METHOD: 7560 students of 73 schools were self-administered the OCD subsection of Clinical Interview Schedule-Revised, the Composite International Diagnostic Interview (CIDI) for obsessive compulsive symptoms and other relevant instruments to identify OCD and related clinical measures. A diagnosis of ICD-10 OCD was derived through the CIS-R algorithm which required duration of at least 2weeks and at least a thought/behavior to be resisted along with a cut-off score for severity and impairment. RESULTS: In the sample, 50.3% were males with a mean age of 15.2years (range of 12-18years). The response rate was 97.3% (7380 valid responses). 0.8% (n=61) fulfilled criteria for OCD with a male predominance (1.1 vs. 0.5%, p=0.005). Prevalence was higher among Muslims and increased with age. Taboo thoughts (62.3%) and mental rituals (45.9%) were the commonest symptoms. Those with OCD had significantly higher suicidal thoughts (59 vs. 16.3%, p<0.01) suicide attempts (24.6 vs. 3.8%, p<0.01), ADHD (28 vs. 4%, p<0.001), sexual abuse (24.6 vs. 4.2%, p<0.01), and tobacco use (23 vs. 6.8%, p=0.01). They also reported greater psychological distress and poorer academic performance. CONCLUSIONS: OCD is common among adolescents in India. Its associations with ADHD, sexual abuse, psychological distress, poorer academic performance and suicidal behavior are additional reasons for it to be recognized and treated early.

Prevalence and correlates of alcohol use among adolescents attending school in Kerala, India.

INTRODUCTION AND AIMS: Concern around potentially increasing alcohol use among young people has been growing in public discourse in India. However, there are few published studies on this issue. We studied the prevalence, patterns and correlates of alcohol use among adolescents in Ernakulam, Kerala State, India. DESIGN AND METHODS: A total of 7560 students in the age group 12-19 years from 73 schools completed a self-administered questionnaire incorporating standardised instruments to assess alcohol use. RESULTS: The overall prevalence of lifetime alcohol among adolescents use was 15% (23.2% among boys and 6.5% among girls) with prevalence increasing with age, and 25.3% of drinkers reported hazardous alcohol use. The mean age at onset of alcohol use was 13.6 years. Initiation of alcohol use typically preceded use of tobacco and illicit drugs. Most students reported initiation into alcohol use by family members in the context of family celebrations. The prevalence of alcohol use was higher among students from urban areas and those with a part-time job. Lower use was seen among Muslims. Lifetime alcohol use was associated with significantly higher tobacco and illicit drug use, suicidal thoughts, attention deficit hyperactivity disorder symptom-scores, history of non-contact sexual abuse and with poor academic performance. DISCUSSION AND CONCLUSIONS: Alcohol use among adolescents in India deserves greater attention than it has previously received, marked as it is by an early onset and associated with a range of negative mental health problems. [ Jaisoorya T S, Beena K V, Beena M, Ellangovan K, Jose D C, Thennarasu K, Benegal V. Prevalence and correlates of alcohol use among adolescents attending school in Kerala, India. Drug Alcohol Rev 2016;35:523-529].