|Year : 2014 | Volume
| Issue : 1 | Page : 47-53
Ill effects of smoking on general and oral health: Awareness among college going students
Yash Paul1, Nitin Soni1, Rohit Vaid1, P Basavaraj2, Nitin Khuller3
1 Department of Periodontics and Implantology, Golpura, Barwala, Panchkula, Haryana, India
2 Department of Public Health Dentistry, D.J. College of Dental Sciences and Research, Modinagar, Ghaziabad, Uttar Pradesh, India
3 Swami Devi Dayal Hospital and Dental College, Golpura, Barwala, Panchkula, Haryana, India
|Date of Web Publication||18-Aug-2014|
Department of Public Health Dentistry, D. J. College of Dental Sciences and Research, Modinagar, Ghaziabad, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Purpose: This cross-sectional study assessed smoking-related behaviors, experiences, beliefs, knowledge, and prevalence among a sample of college going students. It helped to inform them about the different nicotine replacement therapies (NRTs) available for the cessation of the habit. Materials and Methods: After gaining informed consent, 500 college going students (18-25 years age group) of Swami Devi Dyal Group of Colleges, who are smokers and also willing to participate in the study were surveyed regarding their awareness about and prevalence of ill effects of smoking. The survey was conducted by employing a uniform questionnaire. The questionnaire assessed about the tobacco use, no of cigarettes they smokes every day, what form of smoking do they prefer, early smoking experiences and sensations, factors that might motivate a quit attempt, ill effects of smoking on oral health, other psychosocial variables associated with adolescent smoking and about the different NRTs available. The feedback hence obtained was condensed in the form of objective results, which were analyzed to arrive at meaningful conclusions. Results and Conclusion: According to the study as many as about 90% of the students have reasonably good chances of succeeding in quitting smoking. However, the overwhelming majority (96%) had no idea about different NRTs. This shows a stark lack of awareness as to the means that can help them quit the habit. Thus, we get a clear vision as to the direction of our efforts and feel optimistic as to the outcome too.
Keywords: Nicotine replacement therapy, oral cancer, periodontal disease, smoking, smokers
|How to cite this article:|
Paul Y, Soni N, Vaid R, Basavaraj P, Khuller N. Ill effects of smoking on general and oral health: Awareness among college going students. J Indian Assoc Public Health Dent 2014;12:47-53
| Introduction|| |
Tobacco use is a potent risk factor for many human diseases and conditions including oral cancer, cardiovascular and pulmonary diseases and it has a major deleterious effect on population health. 
There is considerable evidence demonstrating the association of periodontal destruction with cigarette smoking. Cigarette smoking is an important risk factor for periodontal disease. ,, Cigarette smokers are 5 times more likely to develop severe periodontitis than nonsmokers. , A meta-analysis of the effects of smoking on periodontal tissue confirmed smoking as a risk factor for periodontal disease with an odds ratio of 2.82.  Epidemiological data indicate that smokers have a greater incidence of tooth loss than nonsmokers. , Furcation involvement in the molar teeth is also more frequent in smokers than in nonsmokers. , These studies suggest that cigarette smoking increases the susceptibility to periodontal pathogens and to tissue destruction. ,
Cigarette smoking influences periodontal disease through a variety of systemic effects, for example, there is impaired chemotaxis, decreased phagocytosis by both oral and peripheral neutrophils, and reduced antibody production. , A substantial body of evidence is available to demonstrate the local detrimental effects of smoking on periodontal health. These local effects include vasoconstriction caused by nicotine as well as decreased oxygen tension, which may create a favorable subgingival environment for colonization by anaerobic bacteria.  Although it is possible that the heat from cigarette smoking could have a local effect on the periodontium, there is hardly any scientific evidence to support such an effect. Some studies have reported differences in the pattern of periodontal destruction among smokers, which may imply a localized effect of smoking on maxillary palatal surfaces, especially in the anterior region. ,,
Smokers tend to have greater numbers of deeper periodontal pockets and greater mean periodontal probing depth. ,, Studies have also shown greater mean clinical attachment level loss in smokers compared to nonsmokers. , Haffajee and Socransky  found that the patterns of attachment loss in smokers and nonsmokers were different.
Data from National Health and Nutrition Examination Survey III showed that current smokers were more likely to report a need for periodontal treatment and dental extractions than nonsmokers, while former smokers had similar perceived periodontal treatment needs as nonsmokers. ,
Despite this increased perceived treatment need there is a lack of patient awareness regarding the relationship between smoking and periodontal diseases among patients. In one study, only 7% of patients stated that smoking affected their "gums". 
However, evidence obtained from cross-sectional risk assessment studies and several longitudinal studies have suggested the causal role of tobacco smoking is the initiation and progression of periodontitis in humans.
Thus, in this study we attempted to find the knowledge, attitude and practice toward smoking habit and the awareness about its ill-effects among college going students and their willingness to quit smoking.
Aim of the study
- Attempt to find the knowledge and attitude towards smoking habit among college going students and their oral health
- Prevalence of ill-effects of smoking on oral health.
| Materials and Methods|| |
The patients for this study have been selected from Swami Devi Dyal Group of Colleges, Barwala, Panchkula, India.
- College going students
- They were 18-25 years old
- Patient's consent was taken for the study protocol.
Patient's not wiling for the study
A cross-sectional questionnaire study was conducted among 18-25 year old college going students attending various colleges of Swami Devi Dyal Group of Institutions. All the students in the age range of 18-25 years were approached for the study. All those who were current smokers were included into the study only after explaining the study purpose and obtaining informed consent from them. Hence, a total of 500 students participated in the study.
A 31-item self-administered questionnaire was used for the study [Table 1]. Each item was a closed-ended question with a single answer. The questionnaire items included several self-report measures developed and used over numerous studies, as well as, several self-report measures used by other investigators in other studies to measure the knowledge, attitude and practice towards smoking and its ill effects on oral and general health. Twenty subjects pretested the questionnaire to assess the validity and suitable modifications were done before field administration. Reliability was assessed using Cronbach's alpha internal consistency coefficient (the value averaged 0.82).
The questionnaire assessed about the tobacco use, no of cigarettes they smoked every day, what form of smoking do they prefer, early smoking experiences and sensations, factors that might motivate a quit attempt, ill effects of smoking on oral health, other psychosocial variables associated with adolescent smoking and about the different nicotine replacement therapies (NRTs) available [Table 2].
Before the revised survey was administered, prior permissions were obtained from the heads of the respective institutions. Ethical clearance was obtained from the institutional review board. The pretested questionnaire was administered after explaining the study purpose and informing that they were required to complete the entire questionnaire. This was done to reduce drop outs due to incomplete questionnaire. No study subject was forced to complete the questionnaire. Study subjects were not permitted to discuss among themselves while answering the questionnaire and the survey was completed in the presence of the investigator. The investigator clarified doubts and answered students' queries regarding the questionnaire.
Data were analyzed using the SPSS version 15.0. (Produced by SPSS Inc., it was acquired by IBM in 2009) Descriptive statistics included percentages, frequencies, and Chi-square tests were used to find out significant differences (P < 0.05).
| Results|| |
A total of 500 colleges are going students participated in the study. There were 410 males and 90 females among the study population we found that 14% of the students begin to smoke before 18 years of age [Graph 1]; 42% of the students felt the urge to smoke right after waking up in the morning [Graph 2]; 16% of the students were under the impression that smoking helps them beat stress [Graph 3]; 4% of the students felt "cool" or "fashionable" while smoking [Graph 4]; We found that only 4% of the students had good awareness about the effects of smoking on oral health, while 40% had moderate awareness, and 56% of the students had poor awareness [Graph 5]; 4% of the students had prevalence of signs of oral cancer [Graph 6]; 30% of students have good chances of succeeding in quitting the habit of smoking, 50% have moderate and 20% have poor chances [Graph 7]; 4% of the students had moderate awareness about NRT while the remaining 96% of the students had poor awareness [Graph 8].
| Discussion|| |
The present study attempted to assess the knowledge and attitude towards smoking habit among college going students. As many as 14% of the students are more vulnerable to suffering from different ill effects of smoking at a young age, as they have started smoking before the age of 18 years and will have more number of years to smoke if they don't quit. Besides, it has also been observed that college going students who also smoke have a tendency to acquire other bad habits viz. regular and excessive intake of alcohol and drug abuse. 
Forty-two percent of the smokers in our study revealed an urge to smoke right after waking up. This indicates an increased risk of developing lung and head and neck cancers among this section as evident by recent research regarding the timing of smoking the first cigarette of the day. 
In this study, 16% of the smokers smoke more than 20 cigarettes a day. A person is consuming more than 20 cigarettes a day is considered to be a heavy smoker. Heavy smokers can reduce their risk of lung cancer if they decrease smoking by 50%. Students, who have smoked 1 pack year or more, are more prone to oral cancers (1 pack year = 20 cigarettes/day/year). 
Fourteen percent of the students smoke bidis. Bidi smoking is worse than cigarettes because bidis do not contain filter in them. Thus they are more harmful than cigarettes. They contain less tobacco but more nicotine. To keep a bidi lit, you have to take more frequent and deeper puffs. Thus, the smoker ends up inhaling more smoke and taking it deeper into your lungs. The bidis are easily availability and at low cost. Also, due to the misconception that bidis are herbal and therefore less harmful, some youngsters are taking to thinking that it's safe. 
Thirty-two percent of the students believe that smoking beats stress. The reason they feel so is because in <10 s upon the first inhalation, nicotine passes into the bloodstream, crosses the blood brain barrier and begins acting on the brain cells. The nicotine just ingested begins to mimic one of the most important neurotransmitters, acelytcholine. This action provokes the body's excitation chemicals that include adrenaline and noradrenaline, which causes an immediate rush of stimulation by increasing the blood flow to the brain. This leaves smokers feels energized and alert. Within 20-30 min after the last cigarette, however, a smoker's energy level becomes sharply reduced. 
It was surprisingly heartening to know that only 4% of the students considered smoking to be cool or fashionable, considering that the study was based on youngsters (18-25 years). This is encouraging as it tells us about the right kind of psychological attitude of the remaining 96% of the students.
After completing this study, we conclude on the basis of our findings that about 56% of the students have poor awareness about the different ill effects of smoking on oral health. Thus, a lot of awareness programs about the ill effects of smoking on oral health care should take place at regular time intervals at different venues so that the more and more students feel motivated to quit smoking.
Even though, only 4% of the students in our study have revealed the presence of any sign of oral cancer, the revelation assumes disturbing proportions in the light of the fact that since these students have started smoking at a very tender age, more youngsters will have chances of acquiring oral premalignant lesions and even full blown oral cancer.  According to the study as many as about 90% of the students have reasonably good chances in succeeding in quitting smoking. This encourages us as we hope and strive to educate and motivate youngsters to quit the harmful habit.
Only 4% of the total student knows about the different NRT's available. An overwhelming majority (96%) has no idea about NRT. This shows stark lack of awareness as to the means that can help them quit the habit. Thus as doctors it becomes our duty and responsibility to increase the awareness about the different NRT's available so that more and more smokers quit smoking. On the basis of the findings of our study, we conclude that about 56% of the students had poor awareness about the different ill-effects of smoking on oral health. Thus, a lot of awareness programs about the ill effects of smoking on oral health care should take place at regular time intervals at different venues so that the more and more students feel motivated to quit smoking.
| Conclusion|| |
In this study, an attempt was made to feel the pulse of the young generation on the issue of smoking. On one hand, the results regarding the awareness of different aspects of smoking and the presence of signs of cancer are alarming while, on the other hand, we now know that the majority of students is having good chances of quitting and should be aggressively targeted by disseminating knowledge about NRT.
There is a need for targeted and focused tobacco use prevention interventions by adopting a comprehensive approach. Enabling teachers to educate the students regularly regarding tobacco use should be a cornerstone activity. Nongovernmental organizations may be involved in increasing awareness and also in massive public health education campaigns. Moreover, nationally representative data on the prevalence, risk factors and health consequences of tobacco use among adolescents are lacking, thus representing a future public health research priority.
| References|| |
|1.||Newman M, Takei H, Klokkevold P, Carranza F. Carranza's Clinical Periodontology. 10 th ed. New Delhi: Elsevier's; 2007. p. 338-741. |
|2.||Bergström J. Periodontitis and smoking: An evidence-based appraisal. J Evid Based Dent Pract 2006;6:33-41. |
|3.||Heasman L, Stacey F, Preshaw PM, McCracken GI, Hepburn S, Heasman PA. The effect of smoking on periodontal treatment response: A review of clinical evidence. J Clin Periodontol 2006;33:241-53. |
|4.||Bergström J. Tobacco smoking and chronic destructive periodontal disease. Odontology 2004;92:1-8. |
|5.||Haber J. Smoking is a major risk factor for periodontitis. Curr Opin Periodontol 1994;1:12-8. |
|6.||Page RC, Beck JD. Risk assessment for periodontal diseases. Int Dent J 1997;47:61-87. |
|7.||Papapanou PN. Periodontal diseases: Epidemiology. Ann Periodontol 1996;1:1-36. |
|8.||Ahlqwist M, Bengtsson C, Hollender L, Lapidus L, Osterberg T. Smoking habits and tooth loss in Swedish women. Community Dent Oral Epidemiol 1989;17:144-7. |
|9.||Holm G. Smoking as an additional risk for tooth loss. J Periodontol 1994;65:996-1001. |
|10.||Mullally BH, Linden GJ. Molar furcation involvement associated with cigarette smoking in periodontal referrals. J Clin Periodontol 1996;23:658-61. |
|11.||Axelsson P, Paulander J, Lindhe J. Relationship between smoking and dental status in 35-, 50-, 65-, and 75-year-old individuals. J Clin Periodontol 1998;25:297-305. |
|12.||Persson L, Bergström J, Ito H, Gustafsson A. Tobacco smoking and neutrophil activity in patients with periodontal disease. J Periodontol 2001;72:90-5. |
|13.||Palmer RM, Wilson RF, Hasan AS, Scott DA. Mechanisms of action of environmental factors - tobacco smoking. J Clin Periodontol 2005;32 Suppl 6:180-95. |
|14.||Salvi GE, Lawrence HP, Offenbacher S, Beck JD. Influence of risk factors on the pathogenesis of periodontitis. Periodontol 2000 1997;14:173-201. |
|15.||van der Weijden GA, de Slegte C, Timmerman MF, van der Velden U. Periodontitis in smokers and non-smokers: Intra-oral distribution of pockets. J Clin Periodontol 2001;28:955-60. |
|16.||Bergström J, Eliasson S. Noxious effect of cigarette smoking on periodontal health. J Periodontal Res 1987;22:513-7. |
|17.||Bergström J. Cigarette smoking as risk factor in chronic periodontal disease. Community Dent Oral Epidemiol 1989;17:245-7. |
|18.||Haber J, Wattles J, Crowley M, Mandell R, Joshipura K, Kent RL. Evidence for cigarette smoking as a major risk factor for periodontitis. J Periodontol 1993;64:16-23. |
|19.||Schenkein HA, Gunsolley JC, Koertge TE, Schenkein JG, Tew JG. Smoking and its effects on early-onset periodontitis. J Am Dent Assoc 1995;126:1107-13. |
|20.||Haffajee AD, Socransky SS. Relationship of cigarette smoking to attachment level profiles. J Clin Periodontol 2001;28:283-95. |
|21.||Tomar SL, Asma S. Smoking-attributable periodontitis in the United States: Findings from NHANES III. National Health and Nutrition Examination Survey. J Periodontol 2000;71:743-51. |
|22.||Coleman T, Wilson A, Barrett S, Wynne A, Lewis S. Distributing questionnaires about smoking to patients: Impact on general practitioners' recording of smoking advice. BMC Health Serv Res 2007;7:153. |
|23.||Thomas B, Timothy B. The smoking consequences questionare - The subjective expected utility of smoking in college students. J Consult Clin Psychol 1991;3:484-91. |
|24.||Myers MG, McCarthy DM, MacPherson L, Brown SA. Constructing a short form of the smoking consequences questionnaire with adolescents and young adults. Psychol Assess 2003;15:163-72. |
|25.||Cepeda-Benito A, Ferrer AR. Smoking consequences questionnaire - Spanish. Psychol Addict Behav 2000;14:219-30. |
|26.||Gokirmak M, Ozturk O, Bircan A, Akkaya A. The attitude toward tobacco dependence and barriers to discussing smoking cessation: A survey among Turkish general practitioners. Int J Public Health 2010;55:177-83. |
|27.||Lam E, Rolle I, Shin M, Lee KA. Impact of data editing methods on estimates of smoking prevalence, Global Youth Tobacco Survey, 2007-2009. Prev Chronic Dis 2013;10:E38. |
[Table 1], [Table 2]