Introduction

The research focuses on describing public health issue of tobacco use that focuses on global impact and highlighting significant role of India in production and consumption.

The research aims to assess knowledge, awareness and attitudes of adolescents in Tamil Nadu, India for using tobacco. The alarming statistics on tobacco-related deaths and diseases, the study includes research that is the combination of qualitative and quantitative methods that will help in addressing research objectives.

The introduction includes investigating critical aspects of adolescent perceptions towards tobacco. It includes specific focus on knowledge levels, attitudes toward quitting and influence of parental support.

Background

The tobacco epidemic is the public health challenges and it affects 8 million lives annually with more than 7 million deaths that happens because of tobacco use. The crisis is not restricted to particular region but spans across the world. It is important to understand the impact on different populations.

In India, the burden of tobacco-related diseases is increasing that is causing 1.35 million deaths annually and this contributes to overall sickness and mortality rates.

Epidemiological Trends:

The prevalence of tobacco use is a serious concern that includes substantial variations across regions. In India, the situation is alarming, as the country ranks second in tobacco production and consumption (Bassi et al. 2021).

The epidemiological landscape reveals about serious scenario with escalating number of chronic illnesses that is linked to tobacco use. Cancers, cardiovascular diseases and strokes are rising because of the use of Tabacco that is considered major contributors to morbidity and mortality.

The trends include urgent need for targeted research to understand dynamics of tobacco use especially among vulnerable populations like adolescents.

Risk and Protective Factors:

It includes identifying risk and protective factors that is important in designing effective public health interventions. Adolescents in formative years are susceptible to various influences that can create the attitudes and behaviours towards use of tobacco. It includes describing factors like peer pressure, parental attitudes and socio-economic status play important role in determining adolescent tobacco use.

It includes providing parental support and awareness programs that have been identified as potential protective factors. It can help in understanding factors that is imperative for devising targeted interventions that is important for mitigation of tobacco epidemic among adolescents.

Policy Gaps:

The substantial health burden posed by tobacco use includes notable gaps in policies addressing adolescent tobacco use in India. It includes comprehensive and context-specific strategies that describes about demographic group.

The implementation and enforcement of existing tobacco control policies may contribute towards gaps in effective prevention. This includes bridging policy gaps that is important for curbing rising tide of tobacco-related diseases among adolescents in Tamil Nadu.

Justification of the Chosen Topic:

The choice of investigating knowledge, awareness and attitudes among adolescents in Tamil Nadu stems from urgency includes addressing vulnerable population in context of tobacco epidemic. Adolescence is considered as developmental stage are habits that are formed and interventions that can have long lasting impact (MATHEW, 2020).

The high prevalence of tobacco-related diseases in India is combined with unique socio-cultural dynamics of Tamil Nadu. It requires focusing on need for targeted study in specific region.

Research Paradigm:

The adoption of pragmatic research paradigm aligns with complexity of research problem. It includes incorporating qualitative and quantitative methods and the approach allows for holistic understanding of knowledge, attitudes and role of parental support in use of tobacco in adolescents.

The quantitative arm provides numerical data for statistical analysis and qualitative component offers rich insights for underlying factors influencing attitudes and behaviours.

Objectives and Analytic Methods:

1.    Objective: To analyze knowledge levels and awareness about health risks associated with tobacco use among adolescents.

Analytic Method: The cross-sectional survey includes structured questionnaire that is required to be conducted. The questionnaire will assess knowledge levels through multiple-choice questions regarding health risks associated with use of tobacco. Descriptive statistics and inferential analysis like chi-square tests will be used to quantify and compare knowledge levels for different demographic groups.

2.    Objective: To assess attitudes towards quitting of tobacco among adolescents.

Analytic Method: It is combination of closed-ended and Likert scale questions that will be utilized. Attitudinal responses will be analysed for providing descriptive statistics to summarize and compare attitudes for quitting tobacco. Logistic regression can be used to identify factors associated with positive attitudes for quitting use of tobacco.

3.    Objective: To identify the role of parental support on adolescents.

Analytic Method: Qualitative in-depth interviews with adolescents and parents are required to be conducted. Thematic analysis can help to identify recurring themes related to parental support. Quantitative data on parental support is required to be obtained through structured questionnaire. The use of statistical methods like regression analysis will be used to explore associations with adolescent attitudes towards tobacco.

Integration of Objectives:

The integration of objectives in data interpretation stage. The quantitative data will provide numerical insights in prevalence of knowledge, attitudes and parental support and qualitative findings provides depth and context. The integration allows comprehensive understanding of interplay between knowledge, attitudes and parental support that provides better picture of adolescent tobacco use in Tamil Nadu.

SPSS for Data Analysis:

Quantitative data analysis will be conducted using SPSS. Descriptive statistics will be used to summarize demographic characteristics and key variables. Inferential statistics like chi-square tests and logistic regression can help in analysing associations and identify predictors of interest.

Methodology

Aim: 

The aim of research study is to investigate knowledge, awareness and attitudes of adolescents in Tamil Nadu, India for use of tobacco. The study can help in achieving by addressing specific objectives like analysing knowledge levels and awareness about health risks associated with tobacco use, assessing attitudes towards quitting tobacco and identifying the role of parental support on adolescents.

Study Design: 

The research adopts sequential exploratory mixed-methods design. The design describes initial quantitative phase that is followed by qualitative phase allowing comprehensive exploration of research problem. The sequential nature of design enables understanding of interplay between knowledge, attitudes and parental support among adolescents in Tamil Nadu.

Philosophical Research Orientation Paradigm: 

Pragmatism aligns with aim of addressing practical public health issue. This method is suitable for addressing research problem. The combination of qualitative and quantitative methods allows the use of pragmatic approach for reflecting need to obtain understanding of perspectives of adolescents on tobacco use (Abitha, Jain and Ganapathy, 2019). Pragmatism is relevant in public health research that includes ultimate goal for inform interventions and policies that ensures betterment of public health.

Rationale for Pragmatism: 

The selection of pragmatic paradigm is driven by complexity of the research question. Tobacco uses among adolescents is a serious issue that is influenced by different factors including knowledge, attitudes and parental support. Pragmatism allows flexibility in selecting methods that can help in capturing complexity. The quantitative phase provides numerical data on describing knowledge levels, attitudes and parental support. The qualitative phase adds depth and context allowing interpretation of findings.

Quantitative Phase 

Analytic Method: 

Objective 1: To analyse knowledge levels and awareness about health risks associated with tobacco use among adolescents.

The quantitative phase includes cross-sectional survey with representative sample of adolescents in Tamil Nadu. The population size is estimated to be approximately 20 million. The random sampling method will be used for ensuring representation from urban and rural areas.

The analytic method includes descriptive statistics for summarizing knowledge levels and awareness. Chi-square tests will be used for examining associations between demographic variables and knowledge levels.

Objective 2: To assess attitudes towards quitting of tobacco among adolescents.

The cross-sectional survey will be conducted for same sample. The questionnaire will include Likert scale questions that will help in assessing attitudes towards quitting tobacco. Descriptive statistics will be used for summarizing attitudes (Sharma, Ganapathy and Sengottaiyan, 2019). Logistic regression analysis will be used for identification of factors associated with positive attitudes towards quitting.

Integration Point: Integration of objectives in interpretation phase includes quantitative data on knowledge levels, attitudes and parental support.

It provides foundation for understanding prevalence and associations. The qualitative data is obtained in subsequent phase that helps in interpretation by providing contextual insights and illuminating experiences and perceptions of adolescents and parents.

Qualitative Phase 

Analytic Method: 

Objective 3: To identify role of parental support on adolescents.

The interviews with adolescents and parents are required for exploring dynamics of parental support. Thematic analysis is required to identify recurring themes related to parental support. Quantitative data on parental support will be obtained through structured questionnaire. Statistical methods like regression analysis will be used to explore associations with adolescent attitudes towards tobacco.

SPSS for Data Analysis: 

SPSS will be used for quantitative data analysis. This includes descriptive statistics for summarizing survey responses and inferential statistics for examining associations and identifying predictors. The integration of qualitative and quantitative findings will provide with better understanding of research question.

Detailed Research Plan

Population Chosen:

Quantitative Study: The population for quantitative study will be adolescents in Tamil Nadu, India. The stratified random sampling approach will be used for ensuring representation from different districts and urban and rural areas. The sample size will be calculated based on confidence level of 95%, margin of error of 5% and assumed prevalence rate of tobacco use among adolescents.

Qualitative Study: This requires purposive sampling that will be used to select subset of participants from quantitative sample. Participants will include adolescents that exhibit diverse knowledge levels, attitudes and experiences related to tobacco use (Sagar and Gupta, 2020). Parents of selected adolescents will be included to provide insights about role of parental support. The sample size will be determined by data saturation for ensuring comprehensive exploration of themes and experiences.

Data Collection:

Quantitative Data Collection: The structured questionnaire is designed to capture demographic information and knowledge levels about tobacco-related health risks, attitudes towards quitting and perceived parental support. The questionnaire will be pre-tested for providing clarity and cultural appropriateness.

This will have trained research assistants that will administer survey through face-to-face interviews. It will help in ensuring high response rate and minimizing missing data. The survey will be conducted in schools for ensuring diverse representation of adolescents.

Qualitative Data Collection: The interview will have subset of adolescents and parents. The interview guide will be developed based on finding of literature review. Interviews will be audio-recorded to ensure clarity in responses. The qualitative data will provide depth and context to complement quantitative findings.

Data Analysis:

Quantitative Data Analysis: Exposure measures will include demographic variables, knowledge scores, attitudes towards quitting and perceived parental support. The outcome measure will be prevalence of tobacco use among adolescents. Statistical analyses will involve descriptive statistics, chi-square tests to explore associations and logistic regression to identify predictors of tobacco use. SPSS will be used for quantitative data analysis.

Qualitative Data Analysis: Thematic analysis will be used for qualitative data along with transcripts that will be coded by two researchers to enhance reliability. The constant comparative method will be used to refine and validate themes. NVivo software can help in management and organization of qualitative data.

Ethical Issues Considered:

Ethics approval will be taken from Institutional Review Board before initiating the study. Informed consent will be obtained from adolescents and parents. This requires focusing on voluntary participation and right to withdraw without consequences.

Confidentiality and anonymity are required to be maintained in research process (Manju et al. 2020). The sensitive nature of topic includes debriefing mechanism and referral for counselling services that will be established for participants expressing distress. The research team will be trained to handle ethical challenges for ensuring respectful and ethical research environment.

Challenges and Mitigation:

Challenges are included in obtaining parental consent for adolescent participation. It is addressed by involving schools and community leaders in recruitment process. Sensitization sessions will be conducted to ensure participants for understanding purpose and potential impact of study.

The use of local translators is required to overcome language barriers for ensuring accurate communication. Periodic check-ins with participants can help in assessing potential emotional distress and appropriate support services are required to be provided. Continuous communication with school authorities and community leaders is important to ensure trust and cooperation for mitigating potential challenges.

Research Dissemination

1.    National and International Conferences: The research findings are presented at reputable conferences including upcoming conferences in India that focus on public health and adolescent well-being. The platform provides opportunities to engage with experts, policymakers and practitioners for development of dialogue and collaboration.

2.    Scientific Journals: The study results for publication in peer-reviewed scientific journals requires focusing on public health, adolescent health and preventive medicine. It ensures visibility in academic community and facilitates for incorporation of findings in existing body of knowledge.

3.    Community Workshops and Seminars: This requires engaging with local communities through workshops and seminars that is important component of dissemination (Babu et al. 2019). The approach facilitates direct communication of findings to community members, parents and local leaders. It ensures development awareness and understanding of research outcomes.

4.    Social Media and Online Platforms: The development of social media platforms and online channels will broaden reach of research. Infographics, summaries and key messages will be shared to engage wider audience including youth, educators and general public.

Conclusion

It is concluded that research can help in assessing knowledge, awareness and attitudes of adolescents for using tobacco in Tamil Nadu, India. It can help in addressing critical public health issue of global significance. The impact of tobacco epidemic cause millions of deaths annually. It creates urgency of understanding and mitigating effects that is among vulnerable populations like adolescents.

The pragmatic research paradigm requires utilizing qualitative and quantitative methods. This requires addressing objectives ranging from knowledge analysis to exploring role of parental support. The study aims to provide comprehensive understanding of factors influencing adolescent tobacco use.

References

Abitha, S.T., Jain, A. and Ganapathy, D., 2019. Knowledge, attitude, and perception on smoking habits in adolescents in rural area (Thiruvallur district). Drug Invention Today, 11(2).
Babu, N.K., Indiran, M.A., Rathinavelu, P.K. and Doraikannan, S., 2019. Assessing the Awareness of Anti-Tobacco Laws among Adults in Chennai-Need for Strengthening Legal Actions. Indian Journal of Public Health Research & Development, 10(11).
Bassi, S., Bahl, D., Harrell, M.B., Jain, N., Kandasamy, A., Salunke, S.R., Shah, V.G., Raghunathan, P., Markandan, S., Murthy, P. and Arora, M., 2021. Knowledge, attitude, and behaviours on diet, physical activity, and tobacco use among school students: A cross-sectional study in two Indian states. F1000Research, 10.
Manju, J., Krithika, C., Devi, M.S., Saranya, P., Saravanan, R. and Sanjana, N., 2020. Questionnaire Study on Knowledge, Attitude and Practice on Factors Associated with Initiation and Cessation of Tobacco Among Patients Using Tobacco Products. Indian Journal of Forensic Medicine & Toxicology, 14(4).
MATHEW, M.G., 2020. Tobacco Use Among Teenagers In Chennai-A Survey Of Initiation, Prevalence, Knowledge And Attitude. International Journal of Pharmaceutical Research (09752366), 12(4).
Sagar, S. and Gupta, Y.M., 2020. Knowledge, attitude, and awareness of tobacco among tobacco users in South Indian population–A questionnaire-based study. Drug Invention Today, 14(1).
Sharma, N., Ganapathy, D. and Sengottaiyan, V., 2019. Knowledge, attitude, and practice on smoking habits among the adolescents in urban areas. Drug Invention Today, 11(2). 

Appendices

Appendix 1: Participant information sheet and consent form

Participant Information Sheet

Title of Study: Assessment of Knowledge, Awareness, and Attitudes of Adolescents about Tobacco Use in Tamil Nadu, India

Introduction: You are invited to participate in a research study conducted to understand the knowledge, awareness, and attitudes of adolescents regarding tobacco use in Tamil Nadu. Your participation is crucial in contributing to efforts aimed at addressing the significant public health threat posed by the tobacco epidemic.

Purpose: The purpose of this study is to investigate how adolescents in Tamil Nadu perceive and understand the health risks associated with tobacco use, their attitudes towards quitting tobacco, and the role of parental support in influencing their behavior.

Procedures: If you agree to participate, you will be asked to complete a questionnaire that includes questions about your knowledge of tobacco-related health risks, attitudes towards quitting tobacco, and your perception of parental support.

Duration: The questionnaire will take approximately 20 minutes to complete.

Confidentiality: Your responses will be kept confidential, and all data will be anonymized. Only the research team will have access to the collected information.

Risks and Benefits: There are no anticipated risks associated with participating in this study. However, your participation will contribute valuable information that can be used to develop effective interventions for tobacco prevention among adolescents.

Voluntary Participation: Your participation in this study is entirely voluntary. You have the right to withdraw at any time without consequences. Your decision to participate or not will not affect your current or future relationship with the researchers or any affiliated institutions.

Consent Form

I, the undersigned, have read and understood the information provided in the Participant Information Sheet. I have had the opportunity to ask questions, and those questions have been answered satisfactorily. I willingly agree to participate in the study, understanding that my involvement is voluntary, and I may withdraw at any time without consequence.

Participant's Name: _________________________

Signature: _________________________ Date: ________________

For participants under 18:
I, as the legal guardian of the participant, consent to their involvement in the study.

Guardian's Name: _________________________

Signature: _________________________ Date: ________________

 

Appendix 2: Gantt Chart

Assessment of knowledge, awareness and attitudes of adolescents about tobacco use in Tamil Nadu, India
        January 15, 2024                         December 15, 2024

Appendix 3: Questionnaire

Demographic Information:

a. Age:
b. Sex: Male / Female / Other
c. Educational Level:
d. Urban / Rural Residence:

Knowledge about Tobacco:
a. Have you received information about the health risks of tobacco use?
Yes / No
b. Can you identify at least three health risks associated with tobacco use?

Awareness of Health Risks:
a. Rate your awareness of the health risks of tobacco use on a scale of 1-10 (1 being low, 10 being high).
Attitudes towards Quitting:
a. Do you think it's important to quit tobacco use?
Yes / No
b. What factors, if any, would motivate you to quit tobacco?

Parental Support:
a. How would you describe the level of support you receive from your parents regarding tobacco use?
Very Supportive / Supportive / Neutral / Not Supportive / Not Applicable

Tobacco Use Behavior:
a. Do you currently use tobacco products?
Yes / No
b. If yes, specify the frequency and type of tobacco product used.
Sources of Information:
a. Where do you usually get information about tobacco and its health effects?
School / Media / Family / Friends / Other (Specify)

Impact of Awareness Programs:
a. Have you ever participated in any tobacco awareness programs?
Yes / No
b. If yes, did it influence your attitudes towards tobacco use?
Yes / No / Not Sure

Suggestions:
a. What measures do you think would be effective in increasing awareness about the risks of tobacco use among adolescents?
 

Appendix 4: Topic guide for qualitative part of mixed methods.

Introduction:
a. Can you share your general thoughts about tobacco use among adolescents in Tamil Nadu?
b. How do you perceive the impact of tobacco use on the health of adolescents in your community?
Knowledge and Awareness:
a. What information do you think adolescents have about the health risks associated with tobacco use?
b. Are there specific sources of information that are more influential in shaping their awareness?
Attitudes Towards Quitting:
a. In your opinion, what factors influence adolescents' attitudes towards quitting tobacco?
b. How do social and cultural factors play a role in shaping their views on quitting?
Parental Support:
a. How do parents contribute to or hinder adolescents' decisions regarding tobacco use?
b. Can you share examples of positive or negative parental influences in this context?
Peer Influence:
a. How do peer relationships impact adolescents' engagement with tobacco?
b. Are there instances where peer support or pressure plays a significant role?
Community Programs and Interventions:
a. Have there been any community programs addressing tobacco use among adolescents?
b. How effective do you think these programs are, and what improvements can be made?
Perceived Challenges and Solutions:
a. What challenges do adolescents face in resisting or quitting tobacco use?
b. From your perspective, what strategies or interventions could be implemented to address these challenges?
Cultural Perspectives:
a. How do cultural norms and values influence adolescents' behaviors related to tobacco use?
b. Are there cultural practices that either contribute to or mitigate tobacco use among adolescents?
Future Recommendations:
a. Based on your insights, what recommendations would you provide for future initiatives aimed at reducing tobacco use among adolescents?

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