Prevalence of tobacco and arecanut use and associated oral mucosal lesions among adolescent school children of Mathura city

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It is the primary cause of preventable illness, disability, and mortality globally. According to estimates made by the world health organization, currently about 5 million people die prematurely every year in the world due to the use of tobacco and by 2030, it would double to 10 million deaths every year, with about 7 million of the deaths taking place in developing countries. India will experience the highest rate of increase in deaths caused by tobacco, with a significant number of these occurring during the prime working years of adulthood, due to the addiction acquired during youth. The primary risk factors for developing oral precancers and oral cancer are linked to tobacco use and arecanut use. India's tobacco issue is more intricate than that of any other nation, resulting in a significant impact on the health and well-being of its population. The national survey on drug use and health reveals that almost all tobacco use starts during childhood and adolescence. Preventing tobacco product use among youths is critical to decreasing morbidity and mortality because nearly all tobacco product use begins during youth or young adulthood, approximately nine in 10 adult cigarette smokers start before age 18 years. In recent times, tobacco products have expanded to encompass a wide range of smoked, smokeless, and electronic options. Therefore, this study aims to determine the frequency of tobacco and arecanut use and their relationship with oral lesions among adolescent students in mathura city. Methodology A cross-sectional descriptive study will be conducted among adolescent school going children of Mathura city. Ethical approval will be taken from institutional ethics committee of K D Dental College and Hospital, Mathura. A total of 600 adolescent school children will be part of the study. Survey will be conducted according to the WHO Oral health survey form(2013) and guidelines. Information regarding smoking and smokeless tobacco and areca nut use will be ascertained using this questionnaire and modified to suit the present study. The questionnaire consisted of closed-ended questions pertaining to attitude and practice regarding tobacco and arecanut use. Students who fulfilled the inclusion criteria will be included in the study. They will be asked to sit in a classroom then the investigator will distribute the questionnaire to the participants and they will be asked to fill up the questionnaire. Oral examination will be done to ascertain the presence of any oral mucosal lesions associated with the tobacco and areca nut use. The data obtained will be compiled systematically, transformed from a precoded proforma and will be entered into Microsoft Excel, descriptive statistics will be used to analyze the data using SPSS version 23.0. Results According to the research, 10.3% of the people in the study smoked cigarettes. Many more males (8.2%) smoked than did females (2.2%). The reported ages of starting smoking were diverse: 7.1% did so between 14 and 15 years, 1.4% started after age 16, 1.3% between 11 and 13 and 2% before the age of 10.During the past 30 days, 0.7% reported using cigarettes daily and 1.6% only used them on less than 3 days. When it comes to how frequently people smoke, around 1% said they smoked more than 20 cigarettes a day and about 1 out of 30 (3.4%) said they smoked less than once each day.Paying attention to other types of smoking, 11.4% of the participants in this study used bidi or hookah. Smokeless tobacco was used by 7.2% of the population and among that percentage, 5.5% were male and 1.7% were female. Around 4.1% of the respondents began using smokeless tobacco at ages 11–13 and another 2.6% began at ages 14–15.Only a small number of respondents said they used smokeless tobacco: 0.1% used it every day, 1.5% used it between once and twice a week, 0.2% consumed it 20 or more times a day and 3% used it just less than once per day.The study showed that 18.7% of the participants used areca nut and this number was higher for males (12.2%) than for females (6.5%). Out of all study participants, 0.7% used areca nut daily for 30 days, 13.9% used it on average 1–2 days and 6.3% used it less than once a day. All the participants in the study had oral mucosa free of changes seen in smoking, smokeless tobacco or areca nut use. Conclusion The data derived from our study can be utilized by the fellow healthcare investigators to add up to the existing data so that the tangible prevalence rate of tobacco and areca nut users and OPMDs associated with them among children and adolescents can be determined. These data also help us in carrying out interventional measures to reduce the prevalence of tobacco and areca nut chewing habits thereby reducing the prevalence of OPMDs associated with them. The data derived from our study can be used by the policy makers and governmental agencies for the effective implementation of areca nut and tobacco control policies. Tobacco use Areca nut Oral lesions Oral potentially malignant disorders (OPMDs) Adolescents School-going children INTRODUCTION One of the most significant threats to global health today is the tobacco epidemic. It stands as the primary cause of preventable illnesses, disabilities, and fatalities worldwide. The World Health Organization estimates that approximately 5 million individuals die prematurely each year due to tobacco use, and this number is projected to rise to 10 million deaths annually by 2030, with about 7 million of those deaths occurring in developing nations. India is expected to experience the highest increase in tobacco-related deaths, many of which will happen during the productive years of adult life due to addictions formed in youth [ 1 ]. Based on the National Survey on Drug Use and Health, almost all tobacco usage starts during childhood and adolescence. [ 2 ]Preventing the use of tobacco products among young people is essential to reducing illness and death since nearly all tobacco use begins in youth or young adulthood; about 90% of adult cigarette smokers initiate their habits before turning 18. [ 3 ]The adolescent and late childhood years are particularly influential, as students frequently try new activities due to peer pressure and the influence of their parents.[ 4 ] Certain new trends in substance use have surfaced, with the prevalence of multiple substance usage and an increase in tobacco habits among teenage girls.[ 5 ] They are particularly vulnerable to developing substance use habits, especially regarding tobacco and alcohol, due to their easy access and disposable income.[ 4 ] Substance abuse has permeated various sociocultural and economic levels, resulting in decreased productivity.[ 6 ] In recent times, tobacco products have diversified to incorporate a range of smoked, smokeless, and electronic options. In India, the most frequently used tobacco items are smokeless varieties like paan or paan masala containing tobacco, khaini, mishri, and snuff; however, smoking alternatives such as cigarettes, bidis, pipes, and hookah are also prevalent and commonly used.[ 7 ] The Indian Government, through the Cigarettes and Other Tobacco Products Act (COTPA), has imposed restrictions on the sale and advertising of tobacco by prohibiting its sale near educational institutions and banning advertising of tobacco products, even at retail outlets[ 8 ]. Nevertheless, young adolescents still find it easy to obtain these tobacco products. Areca nut is widely consumed by adolescents in India, either alone or mixed with tobacco, in various forms. The primary risk factors for developing oral precancers and oral cancer are linked to the use of tobacco and areca nut. India's issue with tobacco is likely more complicated than that of any other nation globally, resulting in a significant burden of diseases and deaths related to tobacco.[ 9 ] Numerous studies have been reported of tobacco and areca nut use among adults and adolescents from several states of India. However there is a paucity of data in the literature of tobacco and areca nut use among young adolescent school going children in the region of Mathura, western part of Northern state of Uttar Pradesh. Hence the present study was intended to assess the prevalence of tobacco and arecanut use and associated oral lesions among adolescent school children of Mathura city METHODOLOGY The present study was school based cross-sectional study which was carried out in a various educational zones of Mathura city in the state of Uttar Pradesh. The data was collected as per the convenience using random sampling methods to assess the prevalence of tobacco and areca nut use and associated oral mucosal lesions among adolescent school going children of class 8 th to class 10 th in the age group of 13 to17 years. A standard, anonymous, self administered, pretested, questionnaire modified according to Global Youth Tobacco Survey (GYTS) was used in this study.The study was carried out from 16 th October to 16 th December 2023. Uttar Pradesh is the most populous state of the country with a population of 19.98crore as per 2011 censes. Also according to 2011 censes the population of Mathura city is 349909. a. STUDY POPULATION The study population was selected by random sampling methodology. The size of the population was calculated by the formula: n=z.p.q/d^2 Z= A normal deviate reflects the type I error for 95% the citrical value =1.96 P= proportion to be estimated Q=100-p d = The accuracy of estimate(how close to the true proportion) n=(1.96^2)x12x88/(2)^2 =4065.6/4 Sample size n= 1016.4 HENCE THE SAMPLE SIZE OBTAINED WAS 1017 b. STUDY DESIGN This cross sectional study was carried out in various schools of Mathura city. This survey was carried out on students from 8 th standard to 10 th standard ranging from 13 years to 17 years old . The students present on the day of survey were distributed with anonymous, pretested questionnaire . c.OBTAINING APPROVAL FROM SCHOOL Preliminary visit was made in to the school for approval from the respective school authorities for the conduction of the survey. Prior to the conduction of the survey consent was taken from the respective principal. The purpose and the procedure with the impact of this survey on the society was explained with the help of a letter as well as verbally. Although after all these explanation many educational institutions denied permission for the survey without understanding its importance. This highlights the lack of awareness of the teachers of the educational institutions about the menace of tobacco and their ill effects on the health of children. SCHEDULING The average time for the data collection was about 40 minutes for a single class. In a single day maximum 50 students were examined. The entire survey was performed between 15 th October to 15 th December 2023. THE LIST OF SCHOOL EXAMINED The survey was done in the following schools of Mathura city. Rajeev international school Ramanlal Shorawala public school Delhi public school Jain intercollege Indian public school TEAM AND ORGANISATION All the survey was conducted by the principal investigator and was assisted by two other fellow colleagues who helped to distribute and collect the questionnaire performa. SAMPLE INCLUSION AND EXCLUSION CRITERIA All the students who were willing to participate for the survey were distributed the questionnaire performa. Those students who were not willing to participate were asked to sit and not to disturb the class. DATA COLLECTION The study was conducted on 1017 adolescents aged between 13 years to 17 years old. An anonymous, self administered, pretested questionnaire which could be completed in 40 minutes was constructed using simple terms . The questionnaire was administered in English for the English medium school and in Hindi for Hindi medium school. All the instructions were given in Hindi and English. After the survey an intra oral examination was done to identify any mucosal changes in the oral cavity. The subjects were examined in the schools where sufficient natural daylight was available and the subjects were positioned in a way to receive maximum illumination. A brief habit cessation counseling was done after the screening to encourage the children to quit the habit. School authorities were further informed regarding follow-up. The data was collected on occupation and literacy of their parents, amount of money they receive for personal expense. Data were collected on tobacco and areca nut use, the age of initiation of tobacco and areca nut, questions were framed to understand how they initiated tobacco consumption, how many packets of smoking and smokeless tobacco they consume in a day, parental influence or peer pressure was involved or not. Few questions were framed to gather data on public smoking and students’ understanding about the awareness of active and passive smoking. The students were instructed to fill the performa honestly without discussing with their friends to avoid bias in the opinion. Descriptive statistics were obtained and mean, standard deviation, frequency and percentages were calculated. Chi –square test was done to assess the association of gender with tobacco and arecanut consumption. Data was analysed by using SPSS version 19. RESULTS According to the research, 10.3% of the people in the study smoked cigarettes. Many more males (8.2%) smoked than did females (2.2%). The reported ages of starting smoking were diverse: 7.1% did so between 14 and 15 years, 1.4% started after age 16, 1.3% between 11 and 13 and 2% before the age of 10. During the past 30 days, 0.7% reported using cigarettes daily and 1.6% only used them on less than 3 days. When it comes to how frequently people smoke, around 1% said they smoked more than 20 cigarettes a day and about 1 out of 30 (3.4%) said they smoked less than once each day. Paying attention to other types of smoking, 11.4% of the participants in this study used bidi or hookah. Smokeless tobacco was used by 7.2% of the population and among that percentage, 5.5% were male and 1.7% were female. Around 4.1% of the respondents began using smokeless tobacco at ages 11–13 and an other 2.6% began at ages 14–15. Only a small number of respondents said they used smokeless tobacco: 0.1% used it every day, 1.5% used it between once and twice a week, 0.2% consumed it 20 or more times a day and 3% used it just less than once per day. The study showed that 18.7% of the participants used areca nut and this number was higher for males (12.2%) than for females (6.5%). Out of all study participants, 0.7% used areca nut daily for 30 days, 13.9% used it on average 1–2 days and 6.3 % used it less than once a day. All the participants in the study had oral mucosa free of changes seen in smoking, smokeless tobacco or areca nut use. DISCUSSION In this school-based sample (N=1,017), most respondents were 14–15 years old (72.6%) and 56.3% were male (Table 1). Males and females were similarly distributed by age, but males constituted a larger share of the overall sample. These distributions are typical of Indian secondary-school surveys and provide useful context for interpreting sex differences in tobacco and areca-nut behaviors. Cigarette experimentation and current smoking. Overall, 10.3% reported ever trying cigarettes (≥1–2 puffs), with a markedly higher prevalence among males ( 14.5% ) than females ( 5.0% ), and a highly significant association by sex (p<0.001; Table 2). This male excess mirrors other Indian adolescent data. For instance, a Northern India adolescent survey reported that 24.1% had tried tobacco products, with two-thirds of experimenters being boys (small, mixed-mode sample) [10]. In contrast, among early adolescents (10–13 years) from urban slums in Western India, 19.1% were ever tobacco users and 6.2% current users, reflecting both higher experimentation and non-trivial current use in a socioeconomically vulnerable setting [11]. Our lower ever-smoking estimate compared with [10] and [11] likely reflects differences in age structure (more 14–15-year-olds vs. mid- to late-adolescents in [10]) and setting (general schools vs. urban slums in [11]). Age at first cigarette in our cohort clustered in mid-adolescence: 5.7% of all students initiated at 14–15 years and 3.3% before age 14, with significant sex differences (p=0.015; Table 3). The mid-teen onset aligns with clinic- and community-based observations that initiation accelerates after early adolescence; however, slum-dwelling early adolescents in Gujarat showed very early onset , with ~43% of users starting at ≤10 years [11], underscoring context-specific vulnerability. These contrasts reinforce the need to tailor prevention earlier in disadvantaged settings while sustaining mid-teen prevention in general schools. Despite notable experimentation, past-30-day smoking was rare in our data ( 6.6% any days; Table 4) and intensity was low (most smokers reported ≤5 cigarettes/day; Table 5). Frequency distributions did not differ significantly by sex (p=0.644) nor did typical daily consumption (p=0.153). This pattern—high experimentation but low current intensity—echoes school-based observations that many Indian adolescents experiment without quickly transitioning to daily smoking, particularly outside high-deprivation contexts [10,11]. Even so, experimentation is a strong predictor of subsequent escalation, warranting early, universal prevention. Other smoked products. Ever-use of bidi/hookah/other smoked tobacco was 7.3% , higher among males ( 9.2% ) than females ( 4.7% ) with a significant association (p<0.001; Table 6). This aligns with reports that non-cigarette smoked products remain salient among male adolescents, especially where peer models and availability persist [10]. Given the strong cultural and price appeal of bidis, monitoring should include these products rather than focusing on cigarettes alone. Smokeless tobacco (SLT). SLT experimentation was low in our cohort ( 3.6% overall; p=0.004 by sex; Table 7), and past-30-day SLT use was rare ( 3.9% any days; p=0.871; Table 9). Age at first SLT use was significantly associated with sex (p=0.032; Table 8), with most initiations in mid-adolescence. While our SLT prevalence is modest, other Indian settings report heavier SLT involvement among adolescent users—e.g., community-based samples of adolescent tobacco users show SLT predominance and initiation around 15–16 years [11]. Socioeconomic context, social modeling, and product affordability likely explain these discrepancies. Areca nut (supari/betel-nut). Areca-nut initiation was substantially more common than SLT in our data: 18.7% had ever used (by complement of 81.3% “never”), with significant sex differences in age at first use (p=0.006; Table 10), and 20.6% reported any past-30-day use (Table 11). Frequency of daily areca-nut use also differed significantly by sex (p<0.001; Table 12). These findings closely parallel recent school-based data from Mumbai, where areca-only use (without tobacco) among grades 7–9 reached 24.3% , exceeding tobacco-only ( 3.9% ) and dual use ( 1.5% ) [12]. Taken together, areca-nut appears to be the predominant psychoactive oral behavior among Indian early-to-mid adolescents, often preceding or existing independently of tobacco. Given its established carcinogenicity (IARC Group 1), routine school surveillance and targeted messaging on areca-nut are imperative—not just tobacco. Sex differences and effect sizes. Across domains, males consistently exhibited higher experimentation for smoked products (cigarettes and other smoked forms), whereas areca-nut and SLT sex gaps were narrower and, in some settings, may favor females [12,13]. In our study, the unadjusted sex odds ratio for any past-30-day smoking was ~3.25 (95% CI: 2.00–5.29), though category-wise differences in frequency were not statistically significant, suggesting limited power to detect differences at low prevalence. The convergence of our sex-stratified patterns with those reported in diverse Indian settings strengthens external validity. Public health implications. First, prevention should start before mid-adolescence , with particular attention to areca-nut as a culturally accepted gateway behavior. Second, context-sensitive strategies are required: earlier, more intensive interventions in urban-slum schools (where very early initiation is documented) [11], and sustained universal programs in general schools. Third, routine school health programs should track all products (cigarettes, bidis, hookah, SLT, and areca-nut) and incorporate sex-responsive messaging, given consistent male excess in smoked products and high areca-nut uptake across sexes. Strengths and limitations. The present survey’s large sample and granular product-specific measures (initiation age, 30-day frequency, typical daily use) support nuanced inferences. However, school-based, cross-sectional self-report may underestimate sensitive behaviors; comparisons with smaller or differently sampled studies (online surveys, community/slum-based samples) [10,11,12] should be interpreted with sampling frames in mind. Conclusion. In this large school-based cohort, cigarette experimentation is non-trivial but current smoking is infrequent and low-intensity; areca-nut use is both more common and more frequent than tobacco. These patterns are consistent with recent Indian adolescent literature and highlight the need to elevate areca-nut within adolescent oral-health and substance-use prevention, while maintaining comprehensive tobacco control tailored to local risk environments. CONCLUSION The data derived from our study can be utilized by the fellow healthcare investigators to add up to the existing data so that the tangible prevalence rate of tobacco and areca nut users and OPMDs associated with them among children and adolescents can be determined. These data also help us in carrying out interventional measures to reduce the prevalence of tobacco and areca nut chewing habits thereby reducing the prevalence of OPMDs associated with them. The data derived from our study can be used by the policy makers and governmental agencies for the effective implementation of areca nut and tobacco control policies. Implications : The results of our study will help in targeting the adolescent school children for the awareness and educational intervention aimed at reducing tobacco and areca nut use. It will help in early detection of oral mucosal lesions and oral potentially malignant disorders. It will also help in making policy decisions to reduce the burden of tobacco and areca nut use among adolescents. Declarations DECLARATION OF INTEREST The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper FUNDING This research received no external funding. AUTHORS CONTRIBUTION Srenwentu chakraborty was responsible for the conceptualization of the study, data collection, and writing of the manuscript. Ethics Statement This study was conducted in accordance with the Declaration of Helsinki and was reviewed and approved by the Institutional Ethics Committee of KDDC (Approval No. KDDC/IEC/16357/2023). Written informed consent was obtained from all participants (or their legal guardians, where applicable) prior to inclusion in the study. The Committee also reviewed and approved the consent procedures and, where relevant, permitted waiver of consent. Participant Consent Statement Written informed consent was obtained from all participants (or their legal guardians, where applicable) prior to inclusion in the study. The Institutional Ethics Committee of KDDC (Approval No. KDDC/IEC/16357/2023) reviewed and approved the consent procedures. Where applicable, the Committee also permitted waiver of consent. References Petersen PE (2003) Tobacco and Oral Health – The Role of the World Health Organization. ;1:309–15 Tobacco use is one of the chief preventable causes of death in the world. Available from: http://www.who.int/tobacco/surveillance/Serbia%202003.pdf .Wang TW, Gentzke AS, Creamer MR, Cullen KA, Holder-Hayes E, Sawdey MD, Anic GM, Portnoy DB, Hu S, Homa DM, Jamal A, Neff LJ (2019) Tobacco Product Use and Associated Factors Among Middle and High School Students - United States, 2019. MMWR Surveill Summ 68(12):1–22 Narain R, Sardana S, Gupta S (2020) Prevalence and risk factors associated with substance use in children: A questionnaire-based survey in two cities of Uttar Pradesh, India. Indian J Psychiatry 62:517–523 Tsering D, Pal R, Dasgupta A (2010) Licit and illicit substance use by adolescent students in eastern India: Prevalence and associated risk factors. J Neurosci Rural Pract 1:76–81 Sau M, Mukherjee A, Manna N, Sanyal S (2013) Sociodemographic and substance use correlates of repeated relapse among patients presenting for relapse treatment at an addiction treatment center in Kolkata, India. Afr Health Sci 13:791–799 Mistry R, Kleinsasser MJ, Puntambekar N, Gupta PC, McCarthy WJ, Raghunathan T, Adhikari K, Narake S, Hsieh HF, Desai M, Assari S, Alberts J, Pednekar MS (2022) Neighbourhood tobacco retail access and tobacco use susceptibility in young adolescents in urban India. Tob Control 31(e2):e162–e168. 10.1136/tobaccocontrol-2021-056915 Epub 2021 Nov 25. PMID: 34824148; PMCID: PMC9130340 Mission NH (2021) COTPA 2003 AND RULES MADE THEREUNDER. Ministry of Health and Family Welfare, New Delhi Janeswar A, Kumar G, Kanungo S, Singh A, Subramanya GB, Jha K (2019) Prevalence patterns and profile of adolescent tobacco users findings from a youth survey: A cross-sectional study. J Family Med Prim Care 8(6):2017–2022 Lakhute SV, Rathod H, Ray S, Lijhara T, Agarwal KA, Srivastava K (2023) Tobacco and alcohol use among adolescents in Northern India. Ind Psychiatry J 32(Suppl 1):S64–S67 Shah VV, Sharma U, Nayak AH, Paul CV, Parmar SD, Tramboo SK et al (2025) Tobacco use, perceptions, and readiness to quit among early adolescents residing in urban slums of Western India: a mixed-methods study. BMC Public Health 25:1623 Sharma N, Chauhan A, Pandey AK, Kadam YR, Raje S, Kiran K et al (2022) An epidemiological study of addictive behavior pattern among adolescent tobacco users. J Family Med Prim Care. ;11:—. (Open-access article; patterns show mean initiation ≈ 15.6 y and predominance of SLT among adolescent users.) Chandar R, Bharmal RN, Bharmal MN, Saha S, Hosny S, Madathil SA et al (2024) Comparison of school-attending adolescent areca-nut users with non-users: a cross-sectional study. Asian Pac J Cancer Prev 25(7):2411–2419 Tables Table 1 to 12 are available in the Supplementary Files section. Additional Declarations The authors declare no competing interests. Supplementary Files TABLES.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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It stands as the primary cause of preventable illnesses, disabilities, and fatalities worldwide. The World Health Organization estimates that approximately 5\u0026nbsp;million individuals die prematurely each year due to tobacco use, and this number is projected to rise to 10\u0026nbsp;million deaths annually by 2030, with about 7\u0026nbsp;million of those deaths occurring in developing nations. India is expected to experience the highest increase in tobacco-related deaths, many of which will happen during the productive years of adult life due to addictions formed in youth [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Based on the National Survey on Drug Use and Health, almost all tobacco usage starts during childhood and adolescence. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]Preventing the use of tobacco products among young people is essential to reducing illness and death since nearly all tobacco use begins in youth or young adulthood; about 90% of adult cigarette smokers initiate their habits before turning 18. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]The adolescent and late childhood years are particularly influential, as students frequently try new activities due to peer pressure and the influence of their parents.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] Certain new trends in substance use have surfaced, with the prevalence of multiple substance usage and an increase in tobacco habits among teenage girls.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] They are particularly vulnerable to developing substance use habits, especially regarding tobacco and alcohol, due to their easy access and disposable income.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] Substance abuse has permeated various sociocultural and economic levels, resulting in decreased productivity.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] In recent times, tobacco products have diversified to incorporate a range of smoked, smokeless, and electronic options. In India, the most frequently used tobacco items are smokeless varieties like paan or paan masala containing tobacco, khaini, mishri, and snuff; however, smoking alternatives such as cigarettes, bidis, pipes, and hookah are also prevalent and commonly used.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] The Indian Government, through the Cigarettes and Other Tobacco Products Act (COTPA), has imposed restrictions on the sale and advertising of tobacco by prohibiting its sale near educational institutions and banning advertising of tobacco products, even at retail outlets[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Nevertheless, young adolescents still find it easy to obtain these tobacco products. Areca nut is widely consumed by adolescents in India, either alone or mixed with tobacco, in various forms. The primary risk factors for developing oral precancers and oral cancer are linked to the use of tobacco and areca nut. India's issue with tobacco is likely more complicated than that of any other nation globally, resulting in a significant burden of diseases and deaths related to tobacco.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] Numerous studies have been reported of tobacco and areca nut use among adults and adolescents from several states of India. However there is a paucity of data in the literature of tobacco and areca nut use among young adolescent school going children in the region of Mathura, western part of Northern state of Uttar Pradesh.\u003c/p\u003e\u003cp\u003eHence the present study was intended to assess the prevalence of tobacco and arecanut use and associated oral lesions among adolescent school children of Mathura city\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003eThe present study was school based cross-sectional study which was carried out in a various educational zones of Mathura\u0026nbsp;city\u0026nbsp;in the state of Uttar Pradesh. The data was collected as per the convenience using random sampling methods\u0026nbsp;to assess the prevalence of tobacco and areca nut use and associated oral mucosal lesions among adolescent school going children of\u0026nbsp;class 8\u003csup\u003eth\u003c/sup\u003e to class 10\u003csup\u003eth\u003c/sup\u003e in the age group of 13 to17 years. A standard, anonymous, self administered, pretested, questionnaire modified according to Global Youth Tobacco Survey (GYTS) was used in this study.The \u0026nbsp;study was carried out from 16\u003csup\u003eth\u003c/sup\u003e October to 16\u003csup\u003eth\u003c/sup\u003e December 2023. Uttar Pradesh is the most populous state of the country with a population of 19.98crore as per 2011 censes. Also according to 2011 censes the population of Mathura city is 349909.\u003c/p\u003e\n\u003cp\u003ea. STUDY POPULATION\u003c/p\u003e\n\u003cp\u003eThe study population was selected by random sampling methodology. The size of the population was calculated by the formula: n=z.p.q/d^2\u003c/p\u003e\n\u003cp\u003eZ= \u0026nbsp;A normal deviate reflects the type I error for 95% the citrical value =1.96\u003c/p\u003e\n\u003cp\u003eP= proportion to be estimated\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eQ=100-p\u003c/p\u003e\n\u003cp\u003ed = The accuracy of estimate(how close to the true proportion)\u003c/p\u003e\n\u003cp\u003en=(1.96^2)x12x88/(2)^2\u003c/p\u003e\n\u003cp\u003e=4065.6/4 \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSample \u0026nbsp;size n= 1016.4 \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHENCE THE SAMPLE SIZE OBTAINED WAS 1017\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb. STUDY DESIGN\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross sectional study was carried out in various schools of Mathura city. This survey was carried out on students from 8\u003csup\u003eth\u003c/sup\u003e standard to 10\u003csup\u003eth\u003c/sup\u003e\u0026nbsp; standard ranging from 13 years to 17 years old . The students present on the day of survey were distributed with anonymous, pretested questionnaire .\u003c/p\u003e\n\u003cp\u003ec.OBTAINING APPROVAL FROM SCHOOL\u003c/p\u003e\n\u003cp\u003ePreliminary visit was made in to the school for approval from the respective school authorities for the conduction of the survey. Prior to the conduction of the survey consent was taken from the respective principal. The purpose and the procedure with the impact of this survey on the society was explained with the help of a letter as well as verbally. Although after all these explanation many educational institutions denied permission for the survey without understanding its importance. This highlights the lack of awareness of the teachers of the educational institutions about the menace of tobacco and their ill effects on the health of children.\u003c/p\u003e\n\u003cp\u003eSCHEDULING\u003c/p\u003e\n\u003cp\u003eThe average time for the data collection was about 40 minutes for a single class. \u0026nbsp;In a single day maximum 50 students were examined. The entire survey was performed between 15\u003csup\u003eth\u003c/sup\u003e October to 15\u003csup\u003eth\u003c/sup\u003e December 2023.\u003c/p\u003e\n\u003cp\u003eTHE LIST OF SCHOOL EXAMINED\u003c/p\u003e\n\u003cp\u003eThe survey was done in the following schools of Mathura city.\u0026nbsp;\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eRajeev international school\u003c/li\u003e\n \u003cli\u003eRamanlal Shorawala public school\u003c/li\u003e\n \u003cli\u003eDelhi public school\u003c/li\u003e\n \u003cli\u003eJain intercollege\u003c/li\u003e\n \u003cli\u003eIndian public school\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eTEAM AND ORGANISATION\u003c/p\u003e\n\u003cp\u003eAll the survey was conducted by the principal investigator and was assisted by two other fellow colleagues who helped to distribute and collect the questionnaire performa.\u003c/p\u003e\n\u003cp\u003eSAMPLE INCLUSION AND EXCLUSION CRITERIA\u003c/p\u003e\n\u003cp\u003eAll the students who were willing to participate for the survey were distributed the questionnaire performa. Those students who were not willing to participate were asked to sit and not to disturb the class.\u003c/p\u003e\n\u003cp\u003eDATA COLLECTION\u003c/p\u003e\n\u003cp\u003eThe study was conducted on 1017 adolescents aged between 13 years to 17 years old. An anonymous, self administered, pretested questionnaire which could be completed in 40 minutes \u0026nbsp;was constructed using simple terms . The questionnaire was administered in English for the English medium school and in Hindi for Hindi medium school. All the instructions were given in Hindi and English. After the survey an intra oral examination was done to identify any mucosal changes in the oral cavity. The subjects were examined in the schools where sufficient natural daylight was available and the subjects were positioned in a way to receive maximum illumination. A brief habit cessation counseling was done after the screening to encourage the children to quit the habit. School authorities were further informed regarding follow-up.\u003c/p\u003e\n\u003cp\u003eThe data was collected on occupation and literacy of their parents, amount of money they receive for personal expense. Data were collected on tobacco and areca nut use, the age of initiation of tobacco and areca nut, questions were framed to understand how they initiated tobacco consumption, how many packets of smoking and smokeless tobacco they consume in a day, parental influence or peer pressure was involved or not. Few questions were framed to gather data on public smoking and students\u0026rsquo; understanding about the awareness of active and passive smoking. The students were instructed to fill the performa honestly without discussing with their friends to avoid bias in the opinion.\u003c/p\u003e\n\u003cp\u003eDescriptive statistics were obtained and mean, standard deviation, frequency and percentages were calculated. Chi \u0026ndash;square test was done to assess the association of gender with tobacco and arecanut consumption. Data was analysed by using SPSS version 19.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eAccording to the research, 10.3% of the people in the study smoked cigarettes. Many more males (8.2%) smoked than did females (2.2%). The reported ages of starting smoking were diverse: 7.1% did so between 14 and 15 years, 1.4% started after age 16, 1.3% between 11 and \u003cb\u003e13 and 2% before the age of 10.\u003c/b\u003eDuring the past 30 days, 0.7% reported using cigarettes daily and 1.6% only used them on less than 3 days. When it comes to how frequently people smoke, around 1% said they smoked more than 20 cigarettes a day and about 1 out of 30 (3.4%) said they \u003cb\u003esmoked less than once each day.\u003c/b\u003e Paying attention to other types of smoking, 11.4% of the participants in this study used bidi or hookah. Smokeless tobacco was used by 7.2% of the population and among that percentage, 5.5% were male and 1.7% were female. Around 4.1% of the respondents began using smokeless tobacco at ages 11\u0026ndash;13 and an\u003cb\u003eother 2.6% began at ages 14\u0026ndash;15.\u003c/b\u003eOnly a small number of respondents said they used smokeless tobacco: 0.1% used it every day, 1.5% used it between once and twice a week, 0.2% consumed it 20 or more times a day and 3% used \u003cb\u003eit just less than once per day.\u003c/b\u003eThe study showed that 18.7% of the participants used areca nut and this number was higher for males (12.2%) than for females (6.5%). Out of all study participants, 0.7% used areca nut daily for 30 days, 13.9% used it on average 1\u0026ndash;2 days and 6.3\u003cb\u003e% used it less than once a day.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll the participants in the study had oral mucosa free of changes seen in smoking, smokeless tobacco or areca nut use.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this school-based sample (N=1,017), most respondents were 14\u0026ndash;15 years old (72.6%) and 56.3% were male (Table 1). Males and females were similarly distributed by age, but males constituted a larger share of the overall sample. These distributions are typical of Indian secondary-school surveys and provide useful context for interpreting sex differences in tobacco and areca-nut behaviors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCigarette experimentation and current smoking.\u003c/strong\u003e Overall, \u003cstrong\u003e10.3%\u003c/strong\u003e reported ever trying cigarettes (\u0026ge;1\u0026ndash;2 puffs), with a markedly higher prevalence among males (\u003cstrong\u003e14.5%\u003c/strong\u003e) than females (\u003cstrong\u003e5.0%\u003c/strong\u003e), and a highly significant association by sex (p\u0026lt;0.001; Table 2). This male excess mirrors other Indian adolescent data. For instance, a Northern India adolescent survey reported that \u003cstrong\u003e24.1%\u003c/strong\u003e had tried tobacco products, with two-thirds of experimenters being boys (small, mixed-mode sample) [10]. In contrast, among \u003cstrong\u003eearly adolescents (10\u0026ndash;13 years)\u003c/strong\u003e from urban slums in Western India, \u003cstrong\u003e19.1%\u003c/strong\u003e were ever tobacco users and \u003cstrong\u003e6.2%\u003c/strong\u003e current users, reflecting both higher experimentation and non-trivial current use in a socioeconomically vulnerable setting [11]. Our lower ever-smoking estimate compared with [10] and [11] likely reflects differences in age structure (more 14\u0026ndash;15-year-olds vs. mid- to late-adolescents in [10]) and setting (general schools vs. urban slums in [11]).\u003c/p\u003e\n\u003cp\u003eAge at first cigarette in our cohort clustered in mid-adolescence: \u003cstrong\u003e5.7% of all students\u003c/strong\u003e initiated at 14\u0026ndash;15 years and \u003cstrong\u003e3.3%\u003c/strong\u003e before age 14, with significant sex differences (p=0.015; Table 3). The mid-teen onset aligns with clinic- and community-based observations that initiation accelerates after early adolescence; however, slum-dwelling early adolescents in Gujarat showed \u003cstrong\u003every early onset\u003c/strong\u003e, with \u003cstrong\u003e~43% of users starting at \u0026le;10 years\u003c/strong\u003e [11], underscoring context-specific vulnerability. These contrasts reinforce the need to tailor prevention earlier in disadvantaged settings while sustaining mid-teen prevention in general schools.\u003c/p\u003e\n\u003cp\u003eDespite notable experimentation, \u003cstrong\u003epast-30-day smoking\u003c/strong\u003e was rare in our data (\u003cstrong\u003e6.6%\u003c/strong\u003e any days; Table 4) and intensity was low (most smokers reported \u0026le;5 cigarettes/day; Table 5). Frequency distributions did not differ significantly by sex (p=0.644) nor did typical daily consumption (p=0.153). This pattern\u0026mdash;high experimentation but low current intensity\u0026mdash;echoes school-based observations that many Indian adolescents experiment without quickly transitioning to daily smoking, particularly outside high-deprivation contexts [10,11]. Even so, experimentation is a strong predictor of subsequent escalation, warranting early, universal prevention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOther smoked products.\u003c/strong\u003e Ever-use of \u003cstrong\u003ebidi/hookah/other smoked tobacco\u003c/strong\u003e was \u003cstrong\u003e7.3%\u003c/strong\u003e, higher among males (\u003cstrong\u003e9.2%\u003c/strong\u003e) than females (\u003cstrong\u003e4.7%\u003c/strong\u003e) with a significant association (p\u0026lt;0.001; Table 6). This aligns with reports that non-cigarette smoked products remain salient among male adolescents, especially where peer models and availability persist [10]. Given the strong cultural and price appeal of bidis, monitoring should include these products rather than focusing on cigarettes alone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSmokeless tobacco (SLT).\u003c/strong\u003e SLT experimentation was low in our cohort (\u003cstrong\u003e3.6%\u003c/strong\u003e overall; p=0.004 by sex; Table 7), and \u003cstrong\u003epast-30-day SLT use\u003c/strong\u003e was rare (\u003cstrong\u003e3.9%\u003c/strong\u003e any days; p=0.871; Table 9). Age at first SLT use was significantly associated with sex (p=0.032; Table 8), with most initiations in mid-adolescence. While our SLT prevalence is modest, other Indian settings report heavier SLT involvement among adolescent users\u0026mdash;e.g., community-based samples of adolescent tobacco users show SLT predominance and initiation around \u003cstrong\u003e15\u0026ndash;16 years\u003c/strong\u003e [11]. Socioeconomic context, social modeling, and product affordability likely explain these discrepancies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAreca nut (supari/betel-nut).\u003c/strong\u003e Areca-nut initiation was substantially more common than SLT in our data: \u003cstrong\u003e18.7%\u003c/strong\u003e had ever used (by complement of 81.3% \u0026ldquo;never\u0026rdquo;), with significant sex differences in age at first use (p=0.006; Table 10), and \u003cstrong\u003e20.6%\u003c/strong\u003e reported any past-30-day use (Table 11). Frequency of daily areca-nut use also differed significantly by sex (p\u0026lt;0.001; Table 12). These findings closely parallel recent school-based data from Mumbai, where \u003cstrong\u003eareca-only\u003c/strong\u003e use (without tobacco) among grades 7\u0026ndash;9 reached \u003cstrong\u003e24.3%\u003c/strong\u003e, exceeding tobacco-only (\u003cstrong\u003e3.9%\u003c/strong\u003e) and dual use (\u003cstrong\u003e1.5%\u003c/strong\u003e) [12]. Taken together, areca-nut appears to be the predominant psychoactive oral behavior among Indian early-to-mid adolescents, often preceding or existing independently of tobacco. Given its established carcinogenicity (IARC Group 1), routine school surveillance and targeted messaging on areca-nut are imperative\u0026mdash;not just tobacco.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSex differences and effect sizes.\u003c/strong\u003e Across domains, males consistently exhibited higher experimentation for smoked products (cigarettes and other smoked forms), whereas areca-nut and SLT sex gaps were narrower and, in some settings, may favor females [12,13]. In our study, the unadjusted sex odds ratio for any past-30-day smoking was \u003cstrong\u003e~3.25\u003c/strong\u003e (95% CI: 2.00\u0026ndash;5.29), though category-wise differences in frequency were not statistically significant, suggesting limited power to detect differences at low prevalence. The convergence of our sex-stratified patterns with those reported in diverse Indian settings strengthens external validity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePublic health implications.\u003c/strong\u003e First, prevention should start \u003cstrong\u003ebefore mid-adolescence\u003c/strong\u003e, with particular attention to \u003cstrong\u003eareca-nut\u003c/strong\u003e as a culturally accepted gateway behavior. Second, \u003cstrong\u003econtext-sensitive\u003c/strong\u003e strategies are required: earlier, more intensive interventions in urban-slum schools (where very early initiation is documented) [11], and sustained universal programs in general schools. Third, routine school health programs should track \u003cstrong\u003eall\u003c/strong\u003e products (cigarettes, bidis, hookah, SLT, and areca-nut) and incorporate \u003cstrong\u003esex-responsive\u003c/strong\u003e messaging, given consistent male excess in smoked products and high areca-nut uptake across sexes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and limitations.\u003c/strong\u003e The present survey\u0026rsquo;s large sample and granular product-specific measures (initiation age, 30-day frequency, typical daily use) support nuanced inferences. However, school-based, cross-sectional self-report may underestimate sensitive behaviors; comparisons with smaller or differently sampled studies (online surveys, community/slum-based samples) [10,11,12] should be interpreted with sampling frames in mind.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion.\u003c/strong\u003e In this large school-based cohort, cigarette experimentation is non-trivial but current smoking is infrequent and low-intensity; \u003cstrong\u003eareca-nut use is both more common and more frequent\u003c/strong\u003e than tobacco. These patterns are consistent with recent Indian adolescent literature and highlight the need to elevate \u003cstrong\u003eareca-nut\u003c/strong\u003e within adolescent oral-health and substance-use prevention, while maintaining comprehensive tobacco control tailored to local risk environments.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe data derived from our study can be utilized by the fellow healthcare investigators to add up to the existing data so that the tangible prevalence rate of tobacco and areca nut users and OPMDs associated with them among children and adolescents can be determined. These data also help us in carrying out interventional measures to reduce the prevalence of tobacco and areca nut chewing habits thereby reducing the prevalence of OPMDs associated with them. The data derived from our study can be used by the policy makers and governmental agencies for the effective implementation of areca nut and tobacco control policies.\u003c/p\u003e\u003cp\u003e\u003cb\u003eImplications\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThe results of our study will help in targeting the adolescent school children for the awareness and educational intervention aimed at reducing tobacco and areca nut use.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eIt will help in early detection of oral mucosal lesions and oral potentially malignant disorders.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eIt will also help in making policy decisions to reduce the burden of tobacco and areca nut use among adolescents.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eDECLARATION OF INTEREST\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper\u003c/p\u003e\u003ch2\u003eFUNDING\u003c/h2\u003e\u003cp\u003eThis research received no external funding.\u003c/p\u003e\u003ch2\u003eAUTHORS CONTRIBUTION\u003c/h2\u003e\u003cp\u003eSrenwentu chakraborty was responsible for the conceptualization of the study, data collection, and writing of the manuscript.\u003c/p\u003e\u003ch2\u003e\u003cspan\u003eEthics Statement \u003c/span\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cspan\u003eThis study was conducted in accordance with the Declaration of Helsinki and was reviewed and approved by the Institutional Ethics Committee of KDDC (Approval No. KDDC/IEC/16357/2023). Written informed consent was obtained from all participants (or their legal guardians, where applicable) prior to inclusion in the study. The Committee also reviewed and approved the consent procedures and, where relevant, permitted waiver of consent. Participant Consent Statement Written informed consent was obtained from all participants (or their legal guardians, where applicable) prior to inclusion in the study. The Institutional Ethics Committee of KDDC (Approval No. KDDC/IEC/16357/2023) reviewed and approved the consent procedures. Where applicable, the Committee also permitted waiver of consent.\u003c/span\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePetersen PE (2003) Tobacco and Oral Health \u0026ndash; The Role of the World Health Organization. ;1:309\u0026ndash;15\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTobacco use is one of the chief preventable causes of death in the world. 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Tob Control 31(e2):e162\u0026ndash;e168. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/tobaccocontrol-2021-056915\u003c/span\u003e\u003cspan address=\"10.1136/tobaccocontrol-2021-056915\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003eEpub 2021 Nov 25. PMID: 34824148; PMCID: PMC9130340\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMission NH (2021) COTPA 2003 AND RULES MADE THEREUNDER. Ministry of Health and Family Welfare, New Delhi\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJaneswar A, Kumar G, Kanungo S, Singh A, Subramanya GB, Jha K (2019) Prevalence patterns and profile of adolescent tobacco users findings from a youth survey: A cross-sectional study. J Family Med Prim Care 8(6):2017\u0026ndash;2022\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLakhute SV, Rathod H, Ray S, Lijhara T, Agarwal KA, Srivastava K (2023) Tobacco and alcohol use among adolescents in Northern India. Ind Psychiatry J 32(Suppl 1):S64\u0026ndash;S67\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShah VV, Sharma U, Nayak AH, Paul CV, Parmar SD, Tramboo SK et al (2025) Tobacco use, perceptions, and readiness to quit among early adolescents residing in urban slums of Western India: a mixed-methods study. BMC Public Health 25:1623\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSharma N, Chauhan A, Pandey AK, Kadam YR, Raje S, Kiran K et al (2022) An epidemiological study of addictive behavior pattern among adolescent tobacco users. J Family Med Prim Care. ;11:\u0026mdash;. (Open-access article; patterns show mean initiation\u0026thinsp;\u0026asymp;\u0026thinsp;15.6 y and predominance of SLT among adolescent users.)\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChandar R, Bharmal RN, Bharmal MN, Saha S, Hosny S, Madathil SA et al (2024) Comparison of school-attending adolescent areca-nut users with non-users: a cross-sectional study. Asian Pac J Cancer Prev 25(7):2411\u0026ndash;2419\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 to 12 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"K.D. DENTAL COLLEGE","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Tobacco use, Areca nut, Oral lesions, Oral potentially malignant disorders (OPMDs), Adolescents, School-going children","lastPublishedDoi":"10.21203/rs.3.rs-7408404/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7408404/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne of the most significant threats to global health today is the widespread epidemic of tobacco use. It is the primary cause of preventable illness, disability, and mortality globally. According to estimates made by the world health organization, currently about 5 million people die prematurely every year in the world due to the use of tobacco and by 2030, it would double to 10 million deaths every year, with about 7 million of the deaths taking place in developing countries. India will experience the highest rate of increase in deaths caused by tobacco, with a significant number of these occurring during the prime working years of adulthood, due to the addiction acquired during youth. The primary risk factors for developing oral precancers and oral cancer are linked to tobacco use and arecanut use. India's tobacco issue is more intricate than that of any other nation, resulting in a significant impact on the health and well-being of its population. The national survey on drug use and health reveals that almost all tobacco use starts during childhood and adolescence. Preventing tobacco product use among youths is critical to decreasing morbidity and mortality because nearly all tobacco product use begins during youth or young adulthood, approximately nine in 10 adult cigarette smokers start before age 18 years. In recent times, tobacco products have expanded to encompass a wide range of smoked, smokeless, and electronic options. Therefore, this study aims to determine the frequency of tobacco and arecanut use and their relationship with oral lesions among adolescent students in mathura city.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional descriptive study will be conducted among adolescent school going children of Mathura city.\u003c/p\u003e\n\u003cp\u003eEthical approval will be taken from institutional ethics committee of K D Dental College and Hospital, Mathura.\u003c/p\u003e\n\u003cp\u003eA total of 600 adolescent school children will be part of the study. Survey will be conducted according to the WHO Oral health survey form(2013) and guidelines.\u003c/p\u003e\n\u003cp\u003eInformation regarding smoking and smokeless tobacco and areca nut use will be ascertained using this questionnaire and modified to suit the present study. The questionnaire consisted of closed-ended questions pertaining to attitude and practice regarding tobacco and arecanut use. Students who fulfilled the inclusion criteria will be included in the study. They will be asked to sit in a classroom then the investigator will distribute the questionnaire to the participants and they will be asked to fill up the questionnaire. Oral examination will be done to ascertain the presence of any oral mucosal lesions associated with the tobacco and areca nut use.\u003c/p\u003e\n\u003cp\u003eThe data obtained will be compiled systematically, transformed from a precoded proforma and will be entered into Microsoft Excel, descriptive statistics will be used to analyze the data using SPSS version 23.0.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the research, 10.3% of the people in the study smoked cigarettes. Many more males (8.2%) smoked than did females (2.2%). The reported ages of starting smoking were diverse: 7.1% did so between 14 and 15 years, 1.4% started after age 16, 1.3% between 11 and 13 and 2% before the age of 10.During the past 30 days, 0.7% reported using cigarettes daily and 1.6% only used them on less than 3 days. When it comes to how frequently people smoke, around 1% said they smoked more than 20 cigarettes a day and about 1 out of 30 (3.4%) said they smoked less than once each day.Paying attention to other types of smoking, 11.4% of the participants in this study used bidi or hookah. Smokeless tobacco was used by 7.2% of the population and among that percentage, 5.5% were male and 1.7% were female. Around 4.1% of the respondents began using smokeless tobacco at ages 11–13 and another 2.6% began at ages 14–15.Only a small number of respondents said they used smokeless tobacco: 0.1% used it every day, 1.5% used it between once and twice a week, 0.2% consumed it 20 or more times a day and 3% used it just less than once per day.The study showed that 18.7% of the participants used areca nut and this number was higher for males (12.2%) than for females (6.5%). Out of all study participants, 0.7% used areca nut daily for 30 days, 13.9% used it on average 1–2 days and 6.3% used it less than once a day.\u003c/p\u003e\n\u003cp\u003eAll the participants in the study had oral mucosa free of changes seen in smoking, smokeless tobacco or areca nut use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data derived from our study can be utilized by the fellow healthcare investigators to add up to the existing data so that the tangible prevalence rate of tobacco and areca nut users and OPMDs associated with them among children and adolescents can be determined. These data also help us in carrying out interventional measures to reduce the prevalence of tobacco and areca nut chewing habits thereby reducing the prevalence of OPMDs associated with them. The data derived from our study can be used by the policy makers and governmental agencies for the effective implementation of areca nut and tobacco control policies.\u003c/p\u003e","manuscriptTitle":"Prevalence of tobacco and arecanut use and associated oral mucosal lesions among adolescent school children of Mathura city","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-20 11:27:42","doi":"10.21203/rs.3.rs-7408404/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"87937772-d2ae-46bb-bc65-57db4c6ee544","owner":[],"postedDate":"August 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-20T11:27:42+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-20 11:27:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7408404","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7408404","identity":"rs-7408404","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}