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A study conducted by Amrita Institute of Medical Sciences, along with the higher secondary school students in Ernakulam district, found that the students residing in rural area who are exposed to smoke along with a family history of bronchial asthma are at greater risk of getting the chronic inflammatory disease compared with those staying in urban area. "One of the main cause of chronic respiratory disease is active and passive smoking, besides family history. This shows that despite the tobacco control programs in place, school students in Ernakulam reportedly smoke," said one of the author of the study, Dr. Rakesh P.S, Assistant Professor at the Department of Community Medicine, Amrita School of Medicine, Kochi.