|Year : 2019 | Volume
| Issue : 1 | Page : 14-18
Tobacco use: Exploring the beliefs of street food vendors in Delhi, India
Shivam Kapoor, Vikrant Mohanty, Aswini Y Balappanavar
Department of Public Health Dentistry, Maulana Azad Institute of Dental Sciences, MAMC Campus, New Delhi, India
|Date of Submission||30-Oct-2018|
|Date of Acceptance||21-Feb-2019|
|Date of Web Publication||15-Mar-2019|
Dr. Shivam Kapoor
Department of Public Health Dentistry, Maulana Azad Institute of Dental Sciences, MAMC Campus, BSZ Marg, New Delhi - 110 002
Source of Support: None, Conflict of Interest: None
Background: Tobacco-use shows a clear and continual increase with decreasing wealth quintiles. Street vendors are an integral part of the Indian economy, offering potpourri of readily available, inexpensive goods or services in public spaces since time immemorial. Aim: The current study explores tobacco-related knowledge, attitude, and behavior among street food vendors in New Delhi. Materials and Methods: An interview-based questionnaire survey was conducted among food vendors, using prevalidated tool. Apart from demography, 15-item assessed knowledge, attitude, and awareness on tobacco use and control for 2 months. Tobacco usage history was assessed on a 9-item checklist for the users. A total of 147 vendors around a tertiary care public hospital in Central Delhi, who agreed to participate in the study constituted the study sample. The data were analyzed using SPSS version 21. Gender differences for the same were ranked and tested for a significant difference using the Mann–Whitney test. P < 0.05 was considered as statistically significant. Results: The majority of the subset of this sample (n = 127) were found to be tobacco users in either forms (smoke, smokeless, or both). Eighty-seven (68.5%) of the vendors reported the initiation of tobacco use between 18–25 years and 61 (48.03%) participants admitted the morning smoke/dip as most difficult to give up. All of them were aware about the harmful systemic effects of tobacco. Around 66% of the study participants were aware of the existing tobacco legislations in relation to minors and public places. Conclusions: In the current study, most of the food vendors, although aware, were found to be tobacco users. This group constitutes as important socially relevant spot that need rigorous monitoring. Further studies need to collect nationwide data and take effective steps in defining these sites as tobacco-free.
Keywords: Food vendors, India, tobacco-control, tobacco-use
|How to cite this article:|
Kapoor S, Mohanty V, Balappanavar AY. Tobacco use: Exploring the beliefs of street food vendors in Delhi, India. J Indian Assoc Public Health Dent 2019;17:14-8
|How to cite this URL:|
Kapoor S, Mohanty V, Balappanavar AY. Tobacco use: Exploring the beliefs of street food vendors in Delhi, India. J Indian Assoc Public Health Dent [serial online] 2019 [cited 2019 Mar 18];17:14-8. Available from: http://www.jiaphd.org/text.asp?2019/17/1/14/254327
| Introduction|| |
Worldwide, 2.5 billion people are reported to be consuming street food daily, in various forms owing to the ease of availability and financial viability. As per the World Health Organization (WHO) Street-vended foods/street foods are foods and beverages prepared/sold/supplied by vendors in streets/other public places for consumption (immediately or at a later time) without further processing or preparation. These provide a source of readily available, inexpensive, nutritional meals in busy public areas such as school/college pedestrians, footpaths, beaches, rail, and bus stands. Street foods are sold frequently in low- and middle-income countries; however, the variety of food varies according to the regional tapestry and the buyers' preferences.,,,
India is the world's most populous democracy and fourth largest economy where street vending as a profession has been in existence since time immemorial. The largest number of street vendors is reported to be in Mumbai, i.e., 250,000, whereas Delhi has around 200,000. A street vendor is described as a person who offers goods or services for sale to the public without having a permanent built up structure but with a temporary static structure or mobile stall (or head-load). Street vendors may be stationary (public/private settlements/pavements/places) or mobile (push carts or in cycles or baskets on their heads, or may sell their wares in moving bus, etc.) and maybe called as hawker, pheriwalla, rehri-patri walla, footpath dukandars, sidewalk traders, etc.
The sprouting role of food vending sector in terms of employment has been documented immensely; however, several safety concerns are raised., Various regulatory bodies as the Food Safety and Standards Authority of India, and Bureau of Indian Standards have developed food safety standards and guidelines. Although the “National policy For Urban Street Vendors” highlights the importance of “cleanliness” as extremely important and insists on the street vendors to practice self-regulation, yet there are no strict guidelines for tobacco behavior and consumption patterns during their working hours.
It has also been recognized that street food vendors are generally uneducated and belong to poor socioeconomic groups (WHO, 1996). They work for longer hours and working in groups, make peer influence a deciding factor for various instances. This group might engage in deleterious habits such as use of tobacco that could classify as an environmental hazard. Tobacco disrupts human and economic development and keeping these concerns in mind and to encourage broader public and partner participation at all levels, the WHO dedicated the World No Tobacco Day theme “Tobacco: a threat to development” on May 31, 2017. The aim was in line to the sustainable development goals, and its 17 global goals, to ensure that “no one is left behind.” Food vendors, as a microcosm are socially relevant spots and an innovative way of tobacco control can thus be suggested and targeted.
Prior studies all over the world, have generally examined into “personal and food hygiene practices”,,,, by the food vendors/handlers in various public places. Studies have mainly focused on the settlements around schools,, and only one Indian study among food handlers around hospitals has been reported. Considering these discussed facts, the investigators in the current study sought to understand the knowledge regarding health impact of tobacco use, attitude toward tobacco use, and awareness regarding tobacco control policies along with self-reported tobacco use of street food vendors around a tertiary care public hospital in Delhi, India.
| Materials and Methods|| |
This was a cross-sectional study conducted in Central Delhi zone (randomly selected, out of the five zones). Ethical clearance was sorted from the Institutional Review Board (IRB) and study was carried out during October–November 2017 (a total of 49 working days), the food vendors working within a perimeter of 2 km2 of a tertiary care hospital (Maulana Azad Institute of Dental Sciences, Delhi) were approached till redundancy was achieved. Vendors above the age of 18 years and those who consented to participate were included in the study. Food vendors with a permanent stall were excluded, those who could not be contacted even after two visits, were unwilling, refused to participate were excluded from the study. One investigator along with a recording clerk scanned streets for vending vehicles, assessing all streets at least once during usual business hours (12 pm to 4 pm). An interview-based exploratory questionnaire survey was conducted among food vendors (n = 147; 125 males and 22 females).
The self-designed close-ended survey tool (14 items) was pretested for internal consistency (Cronbach's α = 0.83) on fifteen food vendors. The first part of the survey tool collected sociodemographic profile (SES was measured by modified Kuppuswamy scale 2015) and type of foods sold, number of working hours etc., (along with tobacco usage pattern of the users on a 9-item checklist). The second part assessed knowledge-related to health-related impact (6 items) and attitudes/beliefs pertaining to tobacco usage (5 items). The third part collected data on their awareness regarding tobacco-related legislations (three items). They were also enquired regarding the registration of their food establishments. Information on the above mentioned variables were collected using interview technique for 10–15 min in the local language at their respective food establishments.
The data were collected and stored in compliance with the IRB standards, and analyzed using the Statistical Package for the Social Sciences, version 22.0 (SPSS Inc., Chicago, IL, USA). The vendors' knowledge regarding ill-effects of tobacco usage and awareness regarding tobacco legislations was expressed in proportions. The 5-point Likert scale was adapted to rate the beliefs/myths pertaining to tobacco usage (agreement for an established fact was scored as 5 or 4 and disagreement as 1 or 2). Gender differences for the same were ranked and tested for a significant difference using the Mann–Whitney test. P < 0.05 was considered as statistically significant.
| Results|| |
The mean age of the study participants was 34.97 ± 10.59 years along with mean working experience of 11.2 ± 5.9 years. Most of them were found to be married (64.62%) [Table 1]. Out of the 147 vendors, 40.13% were migrants from states of Uttar Pradesh (UP) and Bihar. Majority (60.54%) of the vendors were educated till X standard and only two were graduates. Most (82.31%) of the vendors belonged to upper lower and lower middle class. Nearly 10% of them consumed alcohol and 53 were Smokeless tobacco (SLT) users. The vending categories included mainly ice-cream, roasted peanuts/black grams, egg eateries, popcorn, chanachur, jaggery bars, candyfloss, and Chinese snacks (chowmen, momos etc.). The vending vehicle were mainly cart, truck, temporary stalls, cycle-rickshaw stands and roadside stands selling food. [Table 1] depicts that >two-third vendors initiated tobacco use between 18 and 25 years and nearly half admitted the morning smoke/dip as most difficult to give up (n = 127).
|Table 1: Background characteristics and tobacco usage pattern of street food vendors|
Click here to view
Every 9 out of 10 vendors believed that “tobacco use affects general (98%) and oral health (94%).” All of them knew about the harmful effects of tobacco on heart and lungs [Figure 1]. The various source of information being: media (43%), friends (37%), family (17%), and others (3%). Around two-thirds of the study participants were aware regarding existing tobacco legislations [Figure 2]. While 89% were in agreement to the fact that tobacco is addictive, 66% remained uncertain if SLT is less harmful than the smoked form; and 63% claimed tobacco to help relieve dental pain [Figure 3]. The gender differences found out higher mean ranks for males classifying tobacco as addictive and dental pain relief due to tobacco consumption (P < 0.05). Observations about the vending vehicle were made, wherein most of them were lacking any unique identifier (e.g., permit number, license plate, and distinctive features).
|Figure 2: Awareness among the study participants regarding tobacco-related legislations (n = 147)|
Click here to view
|Figure 3: Tobacco-related attitudes and beliefs among study subjects (n = 147)|
Click here to view
| Discussion|| |
The cuisine of a place speaks volumes about the weather, culture, lifestyle and habits of the people. Indian food vendors undoubtedly are the mascots of rich tapestry of this multi-cultural yarn in any region. Due to their wide cultural acceptability, they might contribute as a very essential socioeconomic group, accounting for nearly 2% of the population of a Metropolis. It is in such settings, a special niche is created that might predispose to promotion of unhealthy practices as tobacco use. It is worth noting that these choices might influence their customer's behavior.
As per the National Policy on urban street vendors (2009), children (>14 years) would not be endorsed for the conduct of vending business. Although, we found out many vendors that were younger, the present study included only those vendors who claimed to be equal or >18 years of age (mean age of 34.97 ± 10.59 years). These findings are comparable to the Pune street vendors (35 ± 13.2 years). Most of the vendors (80%) were found to have migrated from UP and Bihar in the current study while this proportion was around 50% of the vendors from Pune were found to have migrated from these two states.
Many (86.39%) of the vendors in our study were found to use tobacco in any form, which is three times the national average. However, the ratio of SLT users to smokers (1.75 times) among the vendors was lower (2.6 times) for the adults as that reported in the Global Adult Tobacco Survey (GATS-2) India. Although the sample was distributed equally in the three frequencies considered for tobacco consumption, one-third of them reported the first dip/smoke within 5 min of waking up and classified it as the most difficult time to give up. Considering this sample from a different viewpoint, most of them graded tobacco as a substance having addictive potential (men significantly). Another point that warrants special mention is that their age of initiating tobacco use (18-25 years) falls in line with their mean age of commencing this vending business [mean sample age–mean working experience = (34.97 ± 10.59)−(11.2 ± 5.9) years]. This was, however, not enquired while conducting the survey but these findings are thought provoking. These results were again similar to those reported by GATS-2, where the mean age of initiation of tobacco use conforms to 18.9 years. Furthermore, owing to the disproportionate gender distribution, the gender differences are likely to be statistically significant and need to be interpreted cautiously.
The vendors in our study were knowledgeable regarding the health impact of tobacco and the existing legislations in India, which is in line with the countrywide poll. Media was reported as the prime reason for it. However, enforcement of the national comprehensive tobacco control law needs further strengthening. It is worth noting that these vending spots are ‘public places’ first and food-selling business occupancies later. As per Se ction-4 under Cigarettes and Other Tobacco Products Act (COTPA), “Public Place” is defined as any place to which the public has access whether as of right or not and includes all places visited by general public. For this reason, the display of tobacco-free zone at vending stalls can be posited. An unlikely sight that grabbed our attention while conducting the survey was that of the vendors discarding postconsumption waste products such as smoke, discarded butts, and packaging. Apart from the cross-cutting tobacco control activities, addressing the environmental consequences of tobacco is a major concern among this group of population.
A wide sect of the sample was in favor of the beliefs that tobacco relieves dental pain and aids in bowel movement. These might be attributed to their level of education, lifestyle, and upbringing patterns. Since most of the vendors had low comfort with English, the local language (Hindi) with an interview based methodology was employed. Another situation of discomfort was being enquired regarding the display or possession of any official vending permits. Although, this was not our prime objective yet the situation is upsetting as licensing might maintain some kind of back-check reassuring the standards of the sold items. These findings were similar to the study conducted among mobile food vendors from the Bronx neighborhoods. Studies conducted in past in both urban-rural settings suggest that a varied range of items is sold in places of public interest. In line with this, the present study exhibited varied number of eateries as per the requirement of the area that was surveyed.
Street food vendors not only vary in the stuff they offer but also in the constancy of their existence. Regrettably, perhaps, the challenges faced in assessing “moving targets” makes the mobile food vendors as an abandoned research focus area. Noticeably, in the present study, difficulty to data collection was not a constant challenge during the survey days. This could be attributed to well-trained investigators. However, some vendors remained anxious and misunderstood the study investigators for government officials or regulatory authority.
To the best of our knowledge, there is no previously available data portraying the picture of tobacco use among street food vendors in India. We employed exploratory approach and a survey instrument was developed. This study contributes substantially to the existing body of knowledge and opens vistas for further research. However, there were some limitations that need to be considered. The study took place in the two prime festive months of the Indian calendar, but the festive days and evening hours were not included. The distribution of vendor types varies considerably on environmental factors and climatic changes. However, due to limited study duration this study did not consider such factors. At the end of the interview, the vendors were educated about harm involved in tobacco practices by brief one to one counseling.
| Conclusions|| |
This study revealed that majority of the street food vendors though aware about the harmful effects, were found to be tobacco-users. Although they were aware regarding the existing tobacco regulations yet tobacco-related myths were rampant. This group constitutes as important socially relevant spot that need rigorous monitoring. Street food vending is a microcosm where implementation of tobacco-free policy should be done (with regard to Section 4-public place compliance). This could probably be revised in the National policy of the street vendors. Hence, we need to explore their willingness (to implement by the display of tobacco-free zones). A higher prevalence of tobacco users and the signs of nicotine dependence among street vendors might just classify their vending spots as “nicotine dwellings.” Thus, there is an urgent need to collect data and take effective steps, especially on launching community awareness programs for such socially relevant spots like food vendors and to educate them about the consequences of tobacco consumption.
The authors are grateful to the street vendors for their cooperation and the recording clerk in data collection.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
von Holy A, Makhoane FM. Improving street food vending in South Africa: Achievements and lessons learned. Int J Food Microbiol 2006;111:89-92.
Singh AK, Dudeja P, Kaushal N, Mukherji S. Impact of health education intervention on food safety and hygiene of street vendors: A pilot study. Med J Armed Forces India 2016;72:265-9.
Al Mamun M, Rahman SM, Turin TC. Knowledge and awareness of children's food safety among school-based street food vendors in Dhaka, Bangladesh. Foodborne Pathog Dis 2013;10:323-30.
National Health Profile-2017 Part-I (e-Book). Central Bureau of Health Intelligence. Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India; 2017. Available from: http://www.cbhidghs.nic.in/
. [Last accessed on 2018 Jan 30].
Amaami AJ, Dominic D, Collins D. Factors associated with poor food safety compliance among street food vendors in the Techiman Municipality of Ghana. Afr J Food Sci 2017;11:50-7.
Basch CH, Wahrman MZ, MacLean SA, Quisido A, Ponsica C, Patel N, et al.
Glove changing practices of mall food vendors in New Jersey. J Community Health 2018;43:4-10.
Basch CH, Guerra LA, MacDonald Z, Marte M, Basch CE. Glove changing habits in mobile food vendors in New York city. J Community Health 2015;40:699-701.
Estrade M, Dick S, Crawford F, Jepson R, Ellaway A, McNeill G, et al.
Aqualitative study of independent fast food vendors near secondary schools in disadvantaged Scottish Neighbourhoods. BMC Public Health 2014;14:793.
Monney I, Agyei D, Owusu W. Hygienic practices among food vendors in educational institutions in Ghana: The case of Konongo. Foods 2013;2:282-94.
Mudey AB, Kesharwani N, Mudey GA, Goyal RC, Dawale AK, Wagh VV. Health status and personal hygiene among food handlers working at food establishment around a rural teaching hospital in Wardha district of Maharashtra, India. Glob J Helath Sci 2010;2:198-206. Available from: http://www.ccsenet.org/journal/index.php/gjhs/article/view/5723/5902
. [Last accessed on 2019 Feb 28].
Gururaj MS, Shilpa S, Maheshwaran R. Revised socio-economic status scale for urban and rural India – Revision for 2015. Socioecon 2015;4:167-74.
Rane S. Street vended food in developing world: Hazard analyses. Indian J Microbiol 2011;51:100-6.
Asma S, Mackay J, Song SY, Zhao L, Morton J, Palipudi KM, et al.
The GATS Atlas. Atlanta, GA: CDC Foundation; 2015. Available from: http://www.apps.nccd.cdc.gov/gtssdata
. [Last accessed on 2019 Feb 28].
Lucan SC, Varona M, Maroko AR, Bumol J, Torrens L, Wylie-Rosett J, et al.
Assessing mobile food vendors (a.k.a. street food vendors) – Methods, challenges, and lessons learned for future food-environment research. Public Health 2013;127:766-76.
Lucan SC, Maroko AR, Bumol J, Varona M, Torrens L, Schechter CB, et al.
Mobile food vendors in urban neighborhoods-implications for diet and diet-related health by weather and season. Health Place 2014;27:171-5.
[Figure 1], [Figure 2], [Figure 3]