Prevalence, determinants, and perceptions of tobacco use among male college students in Puducherry: a mixed-methods study

Tobacco use remains a critical public health concern in India, particularly among young adults. Understanding the interplay of social, familial, and behavioural influences is vital for effective prevention. So, we aimed to estimate the prevalence of tobacco use among male college students in Puducherry and explore factors influencing initiation and maintenance. A sequential explanatory mixed-methods study was conducted from November 2019 to December 2021, recruiting 750 male undergraduate students through a multistage random sampling technique from ten colleges across five academic streams. Quantitative data were collected using a validated, anonymous questionnaire adapted from the Global Adult Tobacco Survey-2 (GATS-2). Bivariate and Binary logistic regression analyses were performed to identify factors associated with tobacco use. Focus group discussions with users and non-users explored perceptions and experiences, analyzed thematically and integrated for triangulation. The prevalence of ever tobacco use was 10.7% (80/750), with 10.4% (78/750) being current users. Among ever tobacco users, 83.7% (67/80) used smoked forms. Initiation occurred mostly between 15 and 20 years (56/80, 70.0%) and was associated with curiosity and peer pressure. Higher odds of use were associated with older age (AOR 6.54, 95% CI 2.31–18.50), father’s tobacco use (AOR 3.94, 95% CI 1.56–9.96), and peer’s use (AOR 3.62, 95% CI 1.70–7.73); maternal education was protective (AOR 0.14, 95% CI 0.04–0.52). Qualitative themes highlighted peer/family roles, curiosity and media-related perceptions. The prevalence of tobacco use among college students was 10.7%. Initiation and maintenance of tobacco use were associated with curiosity, peer influence, familial factors and media-related perceptions. Interventions must include family and peer engagement and enforce stricter controls on pro-tobacco media content.