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ORIGINAL ARTICLE
Year : 2021  |  Volume : 19  |  Issue : 1  |  Page : 55-60

Awareness of Smokeless Tobacco among Professionals with Sedentary Lifestyles- A Cross Sectional Study


1 Department of Public Health Dentistry, Career Post Graduate Institute of Dental Sciences, Lucknow, Uttar Pradesh, India
2 Department of Public Health Dentistry, Sarsawati Dental College, Lucknow, Uttar Pradesh, India
3 Department of Periodontology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
4 Department of Public Health Dentistry, King's George Medical University, Lucknow, Uttar Pradesh, India
5 Department of Oral Medicine and Radiology, Career Post Graduate Institute of Dental Sciences, Lucknow, Uttar Pradesh, India

Date of Submission12-May-2020
Date of Decision06-Jan-2021
Date of Acceptance15-Feb-2021
Date of Web Publication31-Mar-2021

Correspondence Address:
Pallavi Singh
Q.501, Celebrity Meadows, Sushant Golf City, Ansal Api, Lucknow - 226 002, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_90_20

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  Abstract 


Background: Smokeless tobacco is tobacco orally consumed and not burned. Smokeless tobacco is associated with substantial risks of oral cancer. Smokeless tobacco is the cheapest and very commonly used tobacco product in India. It is highly addictive, is high in carcinogens, and causes a broad spectrum of diseases; yet awareness about its ill effects is low. Aim: The aim is to provide descriptive information on the awareness of smokeless tobacco among software professionals with sedentary lifestyles in Lucknow city, Uttar Pradesh. Subjects and Methods: A descriptive cross-sectional questionnaire survey was conducted. The sampling technique adopted for this study was the two-staged simple random sampling. The first stage consisted of division of city, and then selection of samples was done randomly in the second stage. After giving consent to participate in the study, the final study population was 500 professionals (320 males and 180 females). The 23-item self-administered structured questionnaire with closed-ended questions was formulated. Chi-square test was used to compare the categorical data. Analysis was performed on Statistical Package for the Social Sciences software SPSS, ver. 20.0; SPSS Inc., Chicago, IL, USA. Results: The prevalence of smokeless users among professional was 28.4%. The knowledge of awareness about ingredients (P = 0.016) and harmful effects (P = 0.038) of smokeless tobacco was significantly (P < 0.05) higher among users as compared to nonusers. In contrast, the knowledge about harmful types (betel quid, pan masala with tobacco, pan masala without tobacco, and all these) was higher in nonusers than users (P = 0.021). Conversely, users are significantly more familiar with counseling techniques for quitting tobacco than nonusers (P = 0.017). Conclusion: Most of the software professionals continued the habit of chewing in spite of good knowledge about the hazards of smokeless tobacco. The prevalence of smokeless tobacco users among professionals was 28.4%. Higher prevalence of pan masala with tobacco among professionals was demonstrated by this study, which is not a good sign for the future toward tobacco control.

Keywords: Knowledge, pan masala, professionals, tobacco


How to cite this article:
Malhotra S, Singh P, Dubey H, Mishra G, Agarwal N. Awareness of Smokeless Tobacco among Professionals with Sedentary Lifestyles- A Cross Sectional Study. J Indian Assoc Public Health Dent 2021;19:55-60

How to cite this URL:
Malhotra S, Singh P, Dubey H, Mishra G, Agarwal N. Awareness of Smokeless Tobacco among Professionals with Sedentary Lifestyles- A Cross Sectional Study. J Indian Assoc Public Health Dent [serial online] 2021 [cited 2021 Apr 13];19:55-60. Available from: https://www.jiaphd.org/text.asp?2021/19/1/55/312652




  Introduction Top


Tobacco use is one of the most significant public health issues facing the world today. Tobacco use adversely affects oral health and dental care. It has been directly implicated in numerous oral morbidities.[1]

The mortality rate in India can rise from 1.4% in 1990 to 13.3% in 2020 due to consumption of tobacco usage.[2] Although tobacco deaths rarely make headlines, tobacco kills one person every 6 s.[3] Tobacco can be used in ways ranging from cigarette, cigar, and bidi smoking, to chewing of “smokeless tobacco.” This latter category includes various forms of tobacco, with pan/betel quid being the most common one used. Other forms include naswar, gutka, qiwam, minpuri, and other less known products. Smokeless tobacco is tobacco orally consumed and not burned. In India, it is estimated that 22% of males use smokeless tobacco solely and 8% use smokeless tobacco and smoked tobacco concomitantly.[4]

In contrast to the voluminous literature on the health effects of smoking, relatively little attention has been directed at smokeless tobacco and the factors that promote its use.[5] Software professionals are bound to sit at one place for a longer period of time resulting in development of this habit as smoking is not allowed in such premises. As very few literature are found for software professional related to smokeless tobacco, this study aimed at providing descriptive information on the awareness of smokeless tobacco among software professionals with sedentary lifestyles in Lucknow city, Uttar Pradesh.


  Subjects and Methods Top


A descriptive cross-sectional questionnaire survey was conducted to determine the prevalence and to assess the awareness of smokeless tobacco among software professionals with sedentary lifestyle (tending to spend much time seated). The survey was conducted on the software professionals with sedentary lifestyle in Lucknow city, Uttar Pradesh. The survey was conducted from May 2017 to July 2017.

Prior to data collection, to maintain consistency of the examination, the examiner was trained in the Department of Public Health Dentistry. The examination was carried out by the principal examiner himself. The 23-item self-administered structured questionnaire with closed-ended questions was formulated in English version. In the development of this instrument, special consideration was given to developing a questionnaire, which was completed independently, without assistance. It was, therefore, important that the readability level of the questionnaire was pitched appropriately. Care was taken to avoid long sentences, complex terminology, acronyms or abbreviations, and double-barreled and leading questions. Before and during the survey, the examination method was standardized for validity, reliability, and reproducibility of the data. A coefficient (alpha) of 0.73 was found for validity of questionnaire. Cronbach's alpha of 0.83 was found for reliability of the questionnaire.

The inclusion criteria for the study included software professionals with working hours from 9 AM to 5 PM as it is a usual working hour of software professionals. We had limited the time as increase in duration of hours had effect on the result of the study.

Software professionals who were willing to participate, who can read, write, and understand English, and who were accessible on the day of the survey were included in the study. The exclusion criteria included software professionals with working hours other than 9 AM to 5 PM, who were not willing to participate, and who cannot read, write, and understand English. The investigator had visited the office three times; the professionals who were absent during the visit were also excluded from the study.

The 23-item self-administered structured questionnaire with closed-ended questions was formulated in English version, which included seven questions of knowledge, eight questions of attitude, and eight questions related to practice. The questionnaire included two parts. The first part consisted of recording general information including age, gender, and qualification. The second part consisted of questions pertaining to knowledge, attitude, and practice toward smokeless tobacco habit. Confidentiality of information was ensured.

The sampling technique adopted for this study was the two-staged simple random sampling. The first stage consists of division of city, and then selection of samples was done randomly in the second stage. City was divided into five zones, and from each zone, offices with software professionals working from 9 am to 5 pm were selected randomly.

A pilot study was conducted on 50 subjects using a preformed pro forma with power analysis of 0.8. On the basis of the results obtained, sample size was fixed at 521. It was done to check for the validity of the questionnaire and calculation of sample size. Out of 521 professionals, 21 had given incomplete response and were therefore excluded from the survey. After giving the consent to participate in the study, the final study population was 500 professionals (320 males and 180 females).

Ethical clearance (BBD/EC/025-017 Dated: 2May 2017) was obtained from the ethical clearance committee of the university. Individual informed consent was obtained before the data collection.

Discrete data were summarized in percentage. Categorical groups were compared by Chi-square test. A two-sided (α = 2) P < 0.05 was considered statistically significant. Analysis was performed on Statistical Package for the Social Sciences software SPSS, ver. 20.0; SPSS Inc., Chicago, IL, USA.


  Results Top


In the present study, a sample size consisting of 500 professionals were studied. Among study professional participants mostly were in higher age (>30 years) groups (67.0%), mostly males (64.0%) and graduates (68.0%).

The prevalence of smokeless users among professional was 28.4%. Among professionals, the percentage of smokeless tobacco users was significantly (P < 0.05) higher in higher age groups (>30 years) as compared to lower age groups (≤30 years) (P = 0.012) and more prevalent among males than females (P < 0.001). The prevalence of smokeless tobacco was similar (P = 0.345) among graduate and postgraduate professionals.

The professionals mostly take pan masala with tobacco the most (43.0%) followed by pan masala without tobacco refers to people chewing pan masala and tobacco at different period of time and not together (28.9%), betel quid (22.5%), other than these (4.2%).

Most of the professionals started smokeless tobacco practices after the age of 18 years (54.9%), mostly motivated by friends (54.2%), mostly intake more than 5 packets/day (53.5%), and mostly kept in the mouth more than 25 min (62.7%).

In contrast, number of packets consumed per day differed significantly between the two age groups (P < 0.001). Similarly, the duration of tobacco in the mouth also differed significantly between the two age groups of professionals (P < 0.001) [Table 1].
Table 1: Association of smokeless tobacco use among professional with their demographic characteristics, association of age, and education with different smokeless tobacco use-related practices

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Most of the graduate professionals intake smokeless tobacco at residence (34.7%), while postgraduate professionals mostly take it anywhere (58.5%). Further, most of the graduate (57.4%) and postgraduate (75.6%) professionals kept it in the mouth more than 25 min.

The knowledge of awareness about ingredients (P = 0.016) and harmful effects of smokeless tobacco was significantly (P < 0.05) higher among users as compared to nonusers. In contrast, the knowledge about harmful types (betel quid, pan masala with tobacco, pan masala without tobacco, and all these) was higher in nonusers than users (P = 0.021). Conversely, users have significantly more familiar with counseling techniques for quitting tobacco than nonusers (P = 0.017) [Table 2].
Table 2: Comparison of smokeless tobacco-related knowledge between users and nonusers

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The attitude toward smokeless tobacco among users and nonusers is summarized in [Table 3].
Table 3: Comparison of smokeless tobacco in attitude between users and nonusers

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  Discussion Top


In the present study, a sample size consisting of 500 professionals were studied. The majority (67%) were in higher age groups (>30 years), mostly males (64.0%), and graduates (68.0%). The present study reported that 142 (28.4%) subjects were smokeless tobacco users, which can be compared to the study conducted by Kumari R and Nath B (2008)[6] among male medical students in Lucknow, where the prevalence was 37.5%.

In India, it has been estimated that roughly one-third of women and two-thirds of men use tobacco in one form or another.[7] Among the study professionals in the present study, the use of smokeless tobacco was significantly more prevalent in males (40.9%) than in females (6.1%). The results are in accordance with the study done by Mazahir et al.[8] and Imam et al.[9] This difference might be attributed to the fact that the use of tobacco remains socially accepted for males than females.

The professionals in this study take pan masala with tobacco as the most common form of smokeless tobacco (43.0%), followed by pan masala without tobacco (28.9%), betel quid with tobacco (22.5%), and other forms of smokeless tobacco (4.2%). This was observed because of easy availability of the product and the fact that this habit is a socioculturally accepted practice. Higher prevalence of pan masala with tobacco among professionals was demonstrated by this study. This reflects that industrially prepared chewable products containing betel, areca, and tobacco together, marketed in bright, attractive sachets with appealing brand names, are gaining popularity.[10] These eye-catching labels are commonly available at the tuck shops of most schools and communities.[10] These results can be compared with the study conducted by Mudda and Chandu[11] in Gulbarga city of Karnataka. Other countries where many habitual betel quid chewers add tobacco to their quid include Indonesia, Thailand, Cambodia, the Philippines, and the US territory of Guam. The practice is also found wherever South Asians have emigrated, such as in South Africa, Malaysia, Singapore, Australia, New Zealand, the UK, and the USA.[12] However, Imam et al. reported naswar as the most commonly used form followed by pan among Pakistani medical students. This is because people in North West Frontier Province have cultural practices and preferences similar to those of Central Asia and Afghanistan, where naswar is in common usage.

In the present study, use of tobacco was started due to influence of friends (54.2%). Similar results were observed in the study by Babu et al.[13] among dental professionals in Davangere, where 47.7% of the respondents reported that friends exerted greater influence on the act of using tobacco. Most of the professionals had a habit of taking more than 5 packets per day (53.5%) and keeping it in the mouth for more than 25 min (62.7%). These findings might be attributed to their surrounding environment and sedentary lifestyle. Contrasting results were found in the study done by Mudda and Chandu[11] in the general population of Gulbarga city, Karnataka, in which majority of subjects, i.e., 68.2%, consumed 1–5 tobacco packets per day, and only 31.1% of subjects consumed more than 5 packets per day.

Awareness regarding ingredients (81.7%), harmful effects of smokeless tobacco (64.1%), and counseling techniques for quitting tobacco (68.3%) was found to be more in users when compared to nonusers. These results showed that in spite of having the knowledge about ill effects of tobacco, the study professionals are not able to quit the habit. Attitude for smokeless form to be less risky than smoking form (66.9%) and more harmful to daily users (93.3%) was found to be higher in users. However, attitude for feeling that the habit can be stopped was significantly higher in nonusers (87.4%) as compared to users (73.2%). After assessing the knowledge and attitude of software professionals regarding smokeless tobacco use, there is a need for the health-care providers for developing programs for the prevention and eradication of habit from the professionals.

Quitting the habit by propagating awareness of ill effects of smokeless tobacco was found to be statistically significant among nonusers (34.1%) than in users (19.0%). However, both users (47.9%) and nonusers (38.3%) considered education to be the right way to quit the habit. In the study conducted by Suresh Babu et al.[13] among dental professional of Davangere, Karnataka, 69% were of the opinion that the family members helped most to quit the habit.

In the present study, 85.9% of users and 76.0% of the nonusers expressed their willingness to receive counseling techniques for quitting smokeless tobacco habit. This signifies that the present study population had positive attitude toward receiving counseling techniques for tobacco cessation. Similar results were reported by Mehrotra et al.[14] in a study done on tobacco use by Indian medical students. As positive tobacco cessation knowledge changes may be readily achieved through training, specific tobacco cessation training is needed for software professionals to develop appropriate skills and strategies. This will help in creating awareness among nonusers, which, in turn, helps in the prevention of chewing of smokeless tobacco among their relatives and friends.

The study was limited to urban area. No broad generalization could be made due to limited area of setting. The prevalence of smokeless tobacco users observed in our study could be an underestimation considering the fact that users of tobacco would not have participated in the study despite the assurance of maintaining confidentiality of the information provided.


  Conclusion Top


Despite good knowledge about the hazards of smokeless tobacco, most of the software professionals continued the habit of chewing. The prevalence of smokeless tobacco users among professionals was 28.4%. Higher prevalence of pan masala with tobacco among professionals was demonstrated by this study, which is not a good sign for the future toward tobacco control. The deficiencies in the knowledge of professionals could be addressed by providing appropriate health education and promotion on the aspect of smokeless tobacco use.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Chatterjee T, Haldar D, Mallik S, Sarkar GN, Das S, Lahiri SK. A study on habits of tobacco use among medical and non-medical students of Kolkata. Lung India 2011;28:5-10.  Back to cited text no. 7
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Mazahir S, Malik R, Maqsood M, Merchant KA, Malik F, Majeed A, et al. Socio-demographic correlates of betel, areca and smokeless tobacco use as a high risk behavior for head and neck cancers in a squatter settlement of Karachi, Pakistan. Subst Abuse Treat Prev Policy 2006;1:10.  Back to cited text no. 8
    
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Kumar A, Sinha S, Kumar S, Saran A. A study on knowledge, attitude and practices regarding smokeless tobacco use among adult (more than eighteen years) in the rural area of Jharkhand. Int J Basic Appl Med Sci 2013;3:378-81.  Back to cited text no. 10
    
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Mudda JJ, Chandu GN. Betel quid, areca nut, tobacco habits and understanding of oral cancer risk among general population of Gulbarga city, Karnataka. J Indian Assoc Public Health Dent 2009;14:114-21.  Back to cited text no. 11
    
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Gupta PC, Ray CS. Smokeless tobacco and health in India and South Asia. Respirology 2003;8:419-31.  Back to cited text no. 12
    
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Babu SA, Chandu GN, Pushpanjali K. Tobacco habits, attitudes and prevention among 500 dental professionals of two dental colleges in Davangere, Karnataka. J Indian Assoc Public Health Dent 2006;7:25-9.  Back to cited text no. 13
    
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