Background: The epidemic of tobacco use is shifting from developed to developing countries, including India, where increased use is expected to result in a large disease burden in the future. Changes in prevalence of tobacco use in adolescents are important to monitor, since increased use by young people might be a precursor to increased rates in the population.
Methods: 11 642 students in the sixth and eighth grades in 32 schools in Delhi and Chennai, India, were surveyed about their tobacco use and psychosocial factors related to onset of tobacco use. Schools were representative of the range of types of school in these cities.
Results: Students who were in government schools, male, older, and in sixth grade were more likely to use tobacco than students who were in private schools, female, younger, and in eighth grade. Students in sixth grade were, overall, two to four times more likely to use tobacco than those in eighth grade. 24.8% (1529 of 6165) of sixth-grade students and 9.3% (509 of 5477) of eighth-grade students had ever used tobacco; 6.7% (413 of 6165) and 2.9% (159 of 5477), respectively, were current users. Psychosocial risk factors were greater in sixth-grade than in eighth-grade students. The increase in tobacco use by age within each grade was larger in sixth grade than in eighth grade in government schools, with older sixth-grade students at especially high risk.
Discussion: The finding that sixth-grade students use significantly more tobacco than eighth-grade students is unusual, and might indicate a new wave of increased tobacco use in urban India that warrants confirmation and early intervention.