|Year : 2022 | Volume
| Issue : 1 | Page : 106-110
Assessment of oral health care practices and smokeless tobacco habit among adults in Odisha: A cross-sectional study
Shilpa Mahapatra1, Preetha Elizabeth Chaly2, Smruti Chandan Mohapatra3
1 Department of Public Health Dentistry, S.C.B. Dental College and Hospital, Cuttack, Odisha, India
2 Department of Public Health Dentistry, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
3 Department of Orthodontics and Dentofacial Orthopedics, Hi-Tech Dental College and Hospital, Bhubaneswar, Odisha, India
|Date of Submission||26-Apr-2021|
|Date of Decision||16-May-2021|
|Date of Acceptance||31-Dec-2021|
|Date of Web Publication||25-Feb-2022|
Department of Public Health Dentistry, S.C.B. Dental College and Hospital, Mangalabag, Cuttack - 753 007, Odisha
Source of Support: None, Conflict of Interest: None
Background: Tobacco chewing is an ancient habit dating back to more than 2000 years. Since then, it has spread with remarkable rapidity, seeping into all sections of the society. Aim: The study was carried out to compare the oral health care practices among the tobacco chewers and nonchewers and to record the tobacco chewing habit among the tobacco chewers of Khordha city, Odisha. Materials and Methods: A cross-sectional descriptive study was conducted from March 2015 to August 2015, among 25–64 years old patients attending the dental out-patient department of Gopabandhu Khordha District Headquarter Hospital. The study sample of 512 subjects (256 tobacco chewers and 256 nonchewers), who were age and sex matched, were then interviewed regarding their oral hygiene practices and tobacco chewing habit using a closed-ended questionnaire, derived from the National Youth Tobacco Survey Questionnaire, 2012 and the WHO Oral Health Questionnaire for Adults, 2013. Data obtained were analyzed using Chi-square test. The significance level was set at P ≤ 0.05. Results: All the study subjects had people at home who had the habit of chewing some or the other form of tobacco. Most (73.4%) of the tobacco chewers felt that tobacco chewing probably makes young people look cool or fit in their peer group. Furthermore, 72.2% never saw a warning label on a smokeless tobacco product and 95.3% never had family or friends talk to them about not using any type of tobacco product. However, 87.1% were willing to quit this habit if proper guidance was provided. Conclusion: Tobacco chewing is a socially and culturally acceptable habit in Khordha city, Odisha. Awareness about the harmful effects of tobacco chewing among the users was very low, emphasizing the need to educate and promote awareness about smokeless tobacco products.
Keywords: Awareness, cross-sectional study, oral health, smokeless tobacco
|How to cite this article:|
Mahapatra S, Chaly PE, Mohapatra SC. Assessment of oral health care practices and smokeless tobacco habit among adults in Odisha: A cross-sectional study. J Indian Assoc Public Health Dent 2022;20:106-10
| Introduction|| |
The scourge of tobacco use is one of the greatest perils of global health today. Tobacco is chewed, smoked, sucked, sniffed and is the one product which is detrimental to the population when it is used entirely as intended. Hence, tobacco is the single greatest cause of noncommunicable disease and is likely to produce a world pandemic. In general, sun-or air-cured smokeless tobacco is used in an unprocessed, processed, or manufactured form. It can be used with lime, with areca nut or in a betel quid (pan). Some of the tobacco forms available in India are Hogesoppu (leaf tobacco) and Kaddipudi (powdered sticks) in Karnataka, Gundi (powdered tobacco with coriander seeds, other spices and aromatic, resinous oils) in Gujarat, Orissa and West Bengal, Zarda (tobacco, lime, spices) and Khaini (tobacco and lime) in North India, Mainpuri tobacco, Mawa, Tuibur or Hidakphu (tobacco water) and Gudakhu.
As stated by the Global Adult Tobacco Survey, India, 2016–2017, Odisha with a prevalence of 42.9%, is among the top four states with the highest prevalence of smokeless tobacco use. Khordha is a city in the Indian state of Odisha, where tobacco chewing, especially gutkha and betel quid, is pervasive as well as customary, irrespective of age, gender, or social class. Very few studies have been conducted on the oral health care practices of tobacco chewers in this population. Hence, there was a need to accumulate baseline data for further studies.
This study was designed to compare the oral health care practices among the tobacco chewers and nonchewers and to record the tobacco chewing habit among the tobacco chewers of Khordha city, Odisha.
| Materials and Methods|| |
Study design and study setting
A hospital-based cross-sectional study was carried out among the adult residents aged 25–64 years, who attended the dental outpatient department of Gopabandhu Khordha District Head Quarter Hospital, Odisha.
The study was conducted from March 2015 to August 2015.
Ethical approval and informed consent
Ethical clearance (MADC/IRB/2015/132) and informed consent were obtained. The nature and purpose of the study were explained to the Chief District Medical Officer of Khordha district and prior permission was obtained to conduct the study in the dental out-patient department of Khordha District Head Quarter Hospital.
A pilot study was carried out to determine the feasibility of the study and to pretest the questionnaire. For the pilot study, 100 chewers and 100 nonchewers were randomly selected as exposed and unexposed groups, respectively. The participants of the pilot study were not included in the final results.
Inclusion and exclusion criteria
Subjects using tobacco products other than smokeless tobacco, subjects having alcohol habits, medically compromised patients, or those unwilling to give the full details of their habit were excluded from the study. Those who fulfilled the inclusion and exclusion criteria were matched by age and sex. This resulted in a sample size of 512 which comprised of 256 tobacco chewers and 256 nonchewers.
A closed-ended questionnaire, consisting of 30 questions, was used to interview the study subjects. The questionnaire was derived from two standardized questionnaires namely, the National Youth Tobacco Survey Questionnaire, 2012 and the WHO Oral Health Questionnaire for Adults, 2013. It consisted of demographic information, oral health care practices, and information regarding smokeless tobacco habit. Following data collection, tobacco cessation counseling was provided for the smokeless tobacco users.
The data obtained were subjected to statistical analysis using Statistical Package for Social Science System, SPSS V. 18, IBM Chicago, to obtain the necessary information. Descriptive statistics were obtained for all demographic variables. Data obtained were analyzed using Chi-square test. The statistical significance level was set at P ≤ 0.05.
| Results|| |
Among the tobacco chewers, 51.6% were betel quid chewers, 28.2% were gutkha chewers and 20.3% were both betel quid and gutkha chewers. The demographic characteristics of the study subjects have been illustrated in [Table 1]. The study population consisted of 256 tobacco chewers and 256 nonchewers. They were further stratified into four subgroups according to their age, i.e., 25–34 years old, 35–44 years old, 45–54 years old and 55–64 years old, each. The sample comprised 256 males and 256 females in total. Most of the tobacco chewers (31.3%) and nonchewers (44.5%) were educated till intermediate school. Compared to the tobacco chewers a higher number of tobacco nonchewers were educated till high school (22.3%), intermediate school (44.5%), and graduate/postgraduate level (21.1%). Hence, a higher level of education was observed among the tobacco nonchewers compared to the tobacco chewers (P = 0.001).
|Table 1: Distribution of the study subjects based on their age, gender and education|
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The comparison between tobacco chewers and nonchewers regarding their oral health care practices has been presented in [Table 2] All the study subjects brushed their teeth once daily. Most of the study subjects in both the groups used toothbrushes and toothpaste to clean their teeth. Compared to tobacco chewers (19.5%), a significantly higher number of nonchewers (23.4%) had a habit of mostly having snacks between meals (P = 0.04). Moreover, compared to 13.7% of the chewers 30.5% of the nonchewers had pain or discomfort in their teeth or mouth in the past 12 months, which was statistically also significant (P = 0.001). In addition, compared to 48.8% of the chewers, 59.8% nonchewers never received any dental treatment (P = 0.04). Furthermore, 47.7% of the tobacco chewers and 38.7% of the nonchewers visited the dentist due to pain or trouble with their teeth, gums, or mouth (P = 0.04).
Responses to tobacco chewing habit among the tobacco chewers have been revealed in [Table 3]. Most of the chewers (98.4%) used tobacco ≤10 times per day. Furthermore, 0.8% started using tobacco at the age of 11–20 years, 31.3% had this habit for 6–10 years and 31.2% had been chewing tobacco for more than 10 years. All the tobacco chewers in the study had people at home who had the habit of chewing some or the other form of tobacco. When asked about the source of their tobacco product, 52.8% bought their own tobacco, 25% got it from friends and 22.2% got from family. Only 3.1% thought that there was a time when they wanted to chew tobacco so much that they found it difficult to think of anything else. Majority (98.4%) of the tobacco chewers had this habit 1 h after waking up. Almost half (46.8%) of the tobacco chewers never saw any advertisements or promotions for smokeless tobacco products in newspapers/magazines/internet/movies/billboards. Moreover, 72.2% never saw a warning label on a smokeless tobacco product and 28.6% thought there was no harm due to this habit. Most of the chewers (95.3%) never had any family or friends talk to them, even once, about not using any type of tobacco product and 98% thought tobacco should be allowed inside their home. In spite of the above-reported results, it was important to quit this habit for 71% of chewers and 87.1% were willing to quit this habit if proper guidance was provided.
|Table 3: Responses to tobacco chewing habit characteristics among the tobacco chewers in the study population|
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| Discussion|| |
Tobacco is a psychic camouflage. It renders a person oblivious for the moment to fatigue, business cares, domestic and social infelicities, and other causes of psychic distress. Tobacco cannot take the place of food or rest. It does not solve business problems nor smooth out social or domestic difficulties. The present study was conducted to compare the oral health care practices among the tobacco chewers and nonchewers and to record the tobacco chewing habit among the tobacco chewers of Khordha city, Odisha.
Among the tobacco chewers, 51.6% were betel quid chewers, 28.1% gutkha chewers, and 20.3% both betel quid and gutkha chewers. Betel quid chewers in the present study were much higher than that reported by Saraswathi et al. and Kawatra et al., which could be due to the fact that it is a socially and culturally accepted practice in Odisha. Furthermore, compared to the tobacco chewers a significantly higher number of tobacco nonchewers were educated which was in accordance to a study conducted by Rani et al. In a study conducted by Bedi, the head of the household purchased the betel quid. Whereas in the present study, most of the tobacco chewers bought their own tobacco. In addition, most of the family members, friends, and coworkers of the chewers had the habit of tobacco chewing and the majority never received any advice from family or friends about tobacco use and thought that it should be allowed inside their home, which further ascertains the fact that this habit is socially acceptable at work as well as home.
A significantly higher number of nonchewers had a habit of consuming snacks between meals. The probable reason for this could be that the chewers have the habit of consuming tobacco between meals. Moreover, the tobacco is held in the mouth for a long duration of time, which could have prevented them from snacking. A significantly higher number of chewers had previously visited the dentist due to pain or discomfort. A probable explanation for this could be that the chewers might have more oral health problems than the nonchewers. Majority of the tobacco chewers perceived their oral health as average which was in accordance with a study conducted by Croucher et al.
Very few chewers thought that there was a time when they wanted to chew tobacco so much that they found it difficult to think of anything else, which could be due to the participants' tendency to provide socially acceptable answers to the questionnaire. Moreover, they were apparently not aware of the carcinogenic potential of the tobacco products. Most of them never noticed the warning label on the product. Majority were willing to quit tobacco chewing habit, which was in contrast to the results reported by Prasad et al. where more than half of the chewers were unwilling to quit. The subjects may be actually interested to quit the habit but there was a lack of proper guidance and motivation.
Due to practical difficulties, the present study could not be carried out among the general population of Khordha city. Instead, it was conducted among the patients attending the dental out-patient department of the district headquarter hospital. Hence, the results obtained when extrapolated to the general population should be with prudence, and further studies among chewers and nonchewers from the general population are imperative. Further limitations of this study include recall bias as well as, potential information bias as self-reporting by the patient was used to collect the information.
| Conclusion|| |
In the present study, 51.6% were betel quid chewers, 28.1% gutkha chewers, and 20.3% both betel quid and gutkha chewers. A higher level of education was observed among the tobacco nonchewers compared to the tobacco chewers. Most of the tobacco chewers never noticed the warning label on the product. However, majority were willing to quit tobacco chewing habit. The present study emphasizes the need to educate and promote awareness about smokeless tobacco products, as well as proper tobacco cessation counseling.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]