A survey conducted by National Drug Dependence Treatment Centre and the All India Institute of Medical Sciences has revealed that in Kerala, 74% children between the age group of 5-18 use tobacco.
But Kerala which boasts of the highest literacy rate in the country - over 93.91%, also houses the highest number of cancer patients in the country.
The study included children living in homes with families and those living in streets. "Alcohol, tobacco and inhalants are common initial substances of abuse and have been described as 'gateway substances'. These substances are easily available to the children," the study stated.
It is not illegal to use these substances in the state. In fact, the use is socially accepted and the study says that this point makes it easy for beginners to switch to harder and illicit substances later.
The point can be validated with the fact that today Kerala has the highest per capita liquor consumption in the country. The figure stands at over 8 litres per person annually which leaves behind states such as Punjab and Haryana.
"Even while accepting that the sample veers towards a severe end of the spectrum, the findings regarding use of tobacco among children is highly disturbing," said A Shajahan, Secretary, state Department of General Education.
He added that educational institutions in the state should take a note of this strictly enforce laws, along with spreading awareness.
The study is commissioned by Working Group on Substance Abuse and Drug Addiction among Children under the National Commission for Protection of Child Rights (NCPCR) and covered 4,024 children across 27 states and two union territories.
In India, tobacco could cause 1.5 million deaths a year by 2020 if more users are not persuaded to quit, said an international report published in 2013. At present, China is the world's largest cigarette market.