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ORIGINAL ARTICLE
Year : 2021  |  Volume : 19  |  Issue : 1  |  Page : 22-26

Assessment of tobacco prevalence among employees working in a shopping mall in Panvel, Navi Mumbai, Maharashtra, India


1 Private Practioner, Pune; Private Practitioner, Mumbai, Maharashtra, India
2 Research Director, MGMIHS, MGM University, Navi Mumbai, Maharashtra, India
3 Sr. Lecturer, Department of Public Health Dentistry, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India

Date of Submission18-Aug-2019
Date of Decision11-Jan-2021
Date of Acceptance08-Feb-2021
Date of Web Publication31-Mar-2021

Correspondence Address:
Heena Lachhman Dodeja
M.G.M. Dental College and Hospital, Kamothe, Navi Mumbai - 410 209, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_145_20

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  Abstract 


Background: India is one of the countries in the world where prevalence of smoking and smokeless tobacco use is high. There is a need of cessation programs in various settings, and workplace with high prevalence can be targeted for the same. There are no studies conducted on prevalence of tobacco consumption among employees working at a shopping mall in this part of the country. Aim: This study estimates the prevalence of tobacco use among employees working in a shopping mall in Panvel. Materials and Methods: A descriptive cross-sectional study was conducted among the selected study population of 250 employees using the questionnaire adopted from the Global Adult Tobacco Survey (GATS). Informed consent was taken from every participant. The data were collected by means of a structured questionnaire adopted from GATS. Data collected were entered and statistically analyzed using the Statistical Package for the Social Sciences version 24.0 software (IBM, Armonk, NY, USA). Descriptive and inferential statistical analyses were carried out in the present study. P < 0.05 was considered statistically significant. Results: 73.2% (183) of the employees were nontobacco users and 26.8% (67) consumed tobacco. The prevalence of smoking was 12% (30), and for smokeless, it was 11.6% (29), and 3.2% (8) consumed both forms. It was found that 12% (30) were willing to take help from the counselor to quit the habit and 13.2% (33) were not willing to take help. Conclusions: The present study reflects high prevalence rates of tobacco use among the employees. De-addiction programs and counseling sessions can be conducted for the employees willing to quit tobacco. New policies and tactics on tobacco use need to be explored to ensure the initiation of new tobacco control activities and monitor the existing tobacco control policies.

Keywords: Nicotine dependence, smokeless tobacco, smoking, tobacco use cessation


How to cite this article:
Dodeja HL, Dhameliya VB, Ram SM, Thakkar VP. Assessment of tobacco prevalence among employees working in a shopping mall in Panvel, Navi Mumbai, Maharashtra, India. J Indian Assoc Public Health Dent 2021;19:22-6

How to cite this URL:
Dodeja HL, Dhameliya VB, Ram SM, Thakkar VP. Assessment of tobacco prevalence among employees working in a shopping mall in Panvel, Navi Mumbai, Maharashtra, India. J Indian Assoc Public Health Dent [serial online] 2021 [cited 2021 Jul 30];19:22-6. Available from: https://www.jiaphd.org/text.asp?2021/19/1/22/312638




  Introduction Top


Tobacco is used in India in many forms.[1] Smoking of cigarettes and beedis (tobacco wrapped in dried leaves of special trees) is one form of tobacco use. Smokeless tobacco (SLT) use consists of chewing pan (mixture of lime, pieces of areca nut, tobacco, and spices wrapped in betel leaf), chewing gutkha or pan masala (scented tobacco mixed with lime and areca nut in powder form), and mishri (a kind of toothpaste used for rubbing on gums). India is one of the few countries in the world where prevalence of smoking and SLT use is high and is characterized by dual use of tobacco (use of both smoking and SLT products) which definitely contributes to a noticeable proportion.[2] Tobacco consumption is associated with major ill effects on the health of an individual. Tobacco consumption is a major preventable cause of death. It is also a significant risk factor for development of cardiovascular diseases.[3] There are different populations among whom tobacco consumption varies. For example, there is a high prevalence of tobacco consumption in schoolchildren as well which is reported in few studies.[4]

Continuation of smoked form of tobacco consumption over a long period of time may lead to potentially fatal diseases as lung cancer, coronary artery disease, chronic obstructive pulmonary disease, and stroke.[5] Hence, identification of tobacco users and motivating them to quit the habit is necessary.

There is a need of cessation programs at places where there is a considerable prevalence of tobacco consumption. Workplaces with high prevalence of tobacco consumption among employees can be targeted to plan various cessation programs. Hence, determining the prevalence of tobacco consumption at a particular workplace is essential. Based on the prevalence, various steps can be taken to plan out cessation activities. There was a need to accumulate baseline data for further studies and to assess the effectiveness of different initiatives. Hence, the present study population was selected.

Therefore, this study was planned to estimate the prevalence of tobacco consumption among the employees working at a shopping mall. This study aims at knowing the status of tobacco use among the employees in a shopping mall located in Panvel as no such study has been conducted previously in this population.


  Materials and Methods Top


A descriptive cross-sectional study was conducted among the selected study population of 250 employees at a shopping mall in Panvel, Navi Mumbai, Maharashtra, India. Ethical clearance was obtained from the Institutional Ethics Recognition Committee to conduct this study. Permission was also obtained from the shopping mall authorities to gather data from their employees.

The data were collected over a period of 2 weeks, and rush hours were avoided to collect the data as it would interfere in the functioning of various outlets at the shopping mall. The data were collected from the employees on weekdays considering the increased footfalls of customers and busy schedule of employees in the weekend. The shopping mall provided employment to approximately 250 employees, and all the employees were included in the present study. The nature of the study was explained in detail to the participants, and informed consent was obtained from each participant.

Participant information sheet and informed consent were available in English, Hindi, and Marathi languages. The employees were asked for the language of their choice and consent was obtained after explaining the study details in the preferred language. In our study, the methodology adopted to obtain the response was through an interview method. The questionnaire was not self-administered. Around 2% of the study population was illiterate, and the response was obtained through interview method by explaining the questions in the language of their choice.

Employees not willing to participate were excluded from the study. The data thus collected were kept confidential, and the identity of the participants was not revealed.

A prevalidated structured questionnaire[6] adopted from the Global Adult Tobacco Survey (GATS) was used to assess the prevalence of tobacco consumption among employees working in a shopping mall in Panvel. The questionnaire[6] was translated into three different languages as mentioned above. The questionnaire consisted of demographic details which included the age, gender, marital status, and residence of the participant and also the questionnaire provided information related to commencement of habit, duration, possibly the cause, health effects of the use, and the family background. The questionnaire consisted of around 22 questions that could be answered in the form of YES/NO. The responses were gathered from the study population using an interview method.

Collected data were entered and statistically analyzed using the Statistical Package for the Social Sciences version 24.0 software (IBM, Armonk, NY, USA). Descriptive and inferential statistical analyses were carried out in the present study. Results on continuous measurements were presented on mean ± standard deviation and results on categorical measurements were presented in number (%).


  Results Top


On collecting the data from the 250 employees of the shopping mall, it was found that 18.8% (47) were females and 81.2% (203) were males. Furthermore, 4.8% (12) of the employees reside in rural areas, 38.8% (97) reside in semi-urban areas, and 56.4% (141) reside in urban areas. The majority of the employees thus resided in an urban locality. The mean age of the employees was found to be 26.9 ± 6.5 years.

As for the educational background, 86% (215) of the employees had completed High School Certificate (HSC), whereas 12% (30) employees had completed their Secondary School Certificate (S.S.C), and almost 2% (5) employees were illiterate. The detailed education status of employees is shown in [Figure 1].
Figure 1: Educational status of employees working at the shopping mall

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Our study revealed that 73.2% (183) of the employees were nontobacco users and 26.8% (67) of the employees consumed tobacco in one of the forms [Figure 2]. Out of which, no female employee reported tobacco consumption habit and only the male employees were tobacco consumers. The prevalence of smoke form of tobacco usage was 12% (30), and for SLT, it was 11.6% (29), and 3.2% (8) of the employees consumed tobacco in both the forms [Figure 3]. The mean age of tobacco consumers was found to be 28.1 ± 3.2 years, and the majority of the tobacco consumers were educated. Among the tobacco consumers, 35.9% (23) resided in semi-urban areas, 6.3% (4) resided in rural areas, and 59.7% (40) resided in urban areas.
Figure 2: Prevalence of tobacco consumption among the employees

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Figure 3: Distribution of different types of tobacco consumption habits among the employees

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It was also found that 60.4% (151) of the participants had friends and family that consumed tobacco and 38.8% (97) of the participants had no friends or family that consumed tobacco. Ninety four percent (235) of the participants were aware of the warning labels that are printed on the packets of the tobacco packets and 6% (15) were unaware of any such pictorial or text warnings [Figure 4]. 55.6% (139) of the participants reported that they were exposed to secondhand smoke. 68% (94) of the men and 32% (45) of the women were exposed to secondhand smoke, whereas 44% (110) reported that they were not exposed to secondhand smoke.
Figure 4: Awareness regarding the presence of pictorial warnings on tobacco products among employees

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It was found that 9.2% (23) of the employees were advised by their doctors to quit the habit and 17.6% (44) of the employees were not advised by any health-care professional. It was found that 12% (30) of the participants were willing to take help from the counselor to quit the habit and 14.8% (37) were not willing to take any help.


  Discussion Top


Tobacco use is one of the preventable causes of primary death and disease in the world.[6] The WHO estimated that the proportion of deaths attributed to tobacco usage in India will rise from 1.4% in 1990 to 13.3% in 2020.[7] The study shows the level of awareness among the participants about the warnings on the tobacco packets, and in spite of being aware, they did not take the warnings seriously and continued consuming tobacco. Furthermore, majority of the participants living in urban areas were found to be using smoked form of tobacco (ST), whereas those residing in rural consumed SLT. This trend was observed in many previous studies[8],[9] as well.

On collecting the data from the 250 employees of the shopping mall, it was found that 18.8% (47) were females and 81.2% (203) were males. Furthermore, 4.8% (12) of the employees reside in rural areas, 38.8% (97) reside in semi-urban areas, and 56.4% (141) reside in urban areas. The majority of the employees thus resided in an urban locality. The mean age of the employees was found to be 26.9 ± 6.5 years. In the hospital-based survey, it was found that out of 935 samples, 86% (811) were males and 14% (124) were females. The mean age of the participants was found to be 24 ± 18 years. Another study related to tobacco prevalence in the slum population[10] showed that out of 330 samples, 62.7% (207) were males and 37.2% (123) were females. The mean age of the participants was 34.7 ± 13.8 years.

As for the educational background, 86% (215) of the employees had completed HSC, whereas 12% (30) of the employees had completed their SSC, and almost 2% (5) of the employees were illiterate. Compared to a hospital-based survey, 43.40% (352) males and 77.42% (96) females having the tobacco habit were illiterates. 15.54% (126) of the males and 10.48% (13) of the females were educated up to primary school. 8.88% (72) of the males and 4.84% (6) of the females were educated up to secondary school. 7.77% (63) of the males and 7.26% (9) of the females were educated up to higher secondary school. 24.41% (198) had completed the diploma. The study conducted in the slum population showed that 45.7% (151) of the participants were illiterate, 42.7% (141) had completed primary school, 67.87% (224) had completed higher secondary school, 80.90% (267) had completed middle school, and 91.81% (303) had completed higher school.

The current study shows that 73.2% (183) were nontobacco users and 26.8% (67) consumed tobacco. Out of which, no female consumed tobacco and only males were tobacco consumers. The prevalence of ST usage was 12% (30), and for SLT, it was 11.6% (29), and 3.2% (8) consumed both. In comparison, the GATS 2 result[6] shows that 19.0% (18.9 million) of the males, 2.0% (1.99 million) of the females, and 10.7% (99.5 million) of all adults currently smoke tobacco (ST). 29.6% (59 million) of the males, 12.8% (25.5 million) of the females, and 21.4% (199.4 million) of all adults currently use SLT. 42.4% (96.16 million) of the males, 14.2% (32.2 million) of the females, and 28.6% (266.8 million) of all adults currently use tobacco (smoked and/or smokeless). In a hospital-based survey,[11] the overall prevalence of tobacco use was 16.69% (935) which is less than what was reported in our study. 86.7% (811) of the males and 13.26% (124) of the females consumed tobacco. 75% (608) of the males and 100% (124) of the females consumed smokeless form of tobacco. 25% (203) of the males smoked. Another study in the slum population showed that the prevalence of SLT was higher 47.5% (121) as compared to the prevalence of smoking 28.2% (72), closely followed by dual use 24.3% (51). The prevalence rate was quite high in this study as compared to our study. The prevalence of tobacco consumption was found to be 73.9% (244). The prevalence of tobacco consumption was observed to be higher in males 52.4% (173) compared to 21.5% (71) in females in the slum population.

It was found that 55.6% (139) of the participants reported that they were exposed to secondhand smoke. 68% (94) of the men and 32% (45) of the women were exposed to secondhand smoke, whereas 44% (110) reported that they were not exposed to secondhand smoke. In comparison with GATS 2, 38.7% of the adults were exposed to secondhand smoke at home. 30.2% of the adults who work indoors are exposed to secondhand smoke at their workplace. 7.4% of the adults were exposed to secondhand smoke at restaurants.

It was observed that despite being aware of the presence of label warnings on tobacco products, some of the employees continue to consume tobacco and are not ready to get help to quit the habit. Many of the employees reported that they purchased tobacco products in loose form from the vendors. Hence, few of the participants may have missed observing the pictorial warnings. Limited awareness related to the presence of pictorial warning can also be one of the reasons.

It was found that 9.2% (23) of the employees were advised by their doctors to quit the habit and 17.6% (44) of the employees were not advised by any health-care professional. It was found that 12% (30) of the employees were willing to take help from the counselor to quit the habit and 14.8% (37) were not willing to take any help.

In comparison with GATS 2, 55.4% (55.12 million) of the current smokers are planning or thinking of quitting smoking and 49.6% (98.90 million) of the current SLT users are planning or thinking of quitting SLT use. 48.8% (48.5 million) of the current smokers were advised by health-care providers to quit smoking and 31.7% (63.20 million) of the current SLT users were advised by health-care providers. The study conducted in the slum population showed that the rate of quitting was found to be 4.3% (11).

The current study showed that 94% (235) of the employees were aware of the warning labels that are printed on the packets of the tobacco packets and 6% (15) were unaware of any such pictorial or text warnings. GATS 2 showed that 19.2% of the adults noticed smoking tobacco advertisement and 18.3% of the adults noticed SLT advertisement. 68.0% of adults noticed antismoking tobacco information on television or radio and 59.3% of the adults noticed anti-SLT information on television or radio. 92.4% of the adults believed that smoking causes serious illness and 95.6% of the adults believed that the use of SLT causes serious illness.

It was also found that 60.4% (151) of the employees had friends and family that consumed tobacco and 38.8% (97) of the employees had no friends or family that consumed tobacco. Compared to a hospital-based survey, 48.77% (456) and 25.45% (238) started consuming tobacco due to peer pressure and stress, respectively. 14.65% (137), 3.8% (36), and 6.4% (60) started consumed tobacco due to loneliness, for cleaning the teeth, and workplace, respectively.[11]

The current study showed that the mean age of tobacco consumers was found to be 28.1 ± 3.2 years and majority of the tobacco consumers were educated. Among the tobacco consumers, 35.9% (23) resided in semi-urban areas, 6.3% (4) resided in rural areas, and 59.7% (40) resided in urban areas. In this hospital-based survey,[11] the most affected age group was from 19 to 50 years. 13.45% (753) were below 18 years of age. It was observed that people residing in rural areas were addicted more than the people in urban. The slum population survey showed that the mean age of tobacco consumers was found to be 36.3 ± 13.3 years. A highly significant statistical association was observed between tobacco consumption and age, gender, and occupation. The statistical association between tobacco consumption and religion and education was found to be statistically significant.

The most preferred form of ST in our study was cigarette, and SLT product with the highest consumption was khaini. The preferred form in the hospital-based survey was cigarette 47.1% (114) followed by khaini 42.4% (103), betel nut 28.2% (68), and paan masala 18.8% (45). The survey conducted in the slum population showed that the preferred form was cigarette 47.11% (155) followed by khaini 42.4% (139), betel quid 28.2% (93), and paan masala 18.8% (62).

This finding was similar to those reported in other studies.[10] Majority of our study population did not consume tobacco, but a high percentage of their friends and family were reported to consume tobacco. There was no awareness among the participants about the de-addiction programs and majorities were not willing to take help from the counselor. More research may be needed as to even though almost all participants viewed the warnings, why do some of them continue to consume tobacco and are not ready to get help to quit the habit. As a follow-up, the number of participants who quit tobacco can be evaluated in further study. The participants involved in tobacco consumption will be counseled and referred for further assistance in quitting the habit to the Institutional Tobacco Cessation Center. Further follow-up studies on a similar population will help us to quantify the impact of antitobacco campaigns and activities conducted at the mall by various educational and health institutions.


  Conclusions Top


The present study reflects the high prevalence rates of tobacco use among the working population of the society. It was found that the prevalence was higher in males residing in urban areas with significant use of smoked tobacco. In spite of the awareness of warning advertisements on the tobacco products of harmful health effects, the population is ignorant. Hence, apart from mass against the use of tobacco products, authorities should focus on strict enforcement of law and promote research for creating new and harmless replacement products. New policies and tactics on tobacco use need to be explored to ensure the initiation of new tobacco control activities and monitor the existing tobacco control policies.

Acknowledgment

I wish to express my gratitude to the mall authorities for providing me an opportunity to work on my research titled “Assessment of tobacco prevalence among employees working in a shopping mall in Panvel, Navi Mumbai, Maharashtra, India.”

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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