|Year : 2022 | Volume
| Issue : 1 | Page : 69-74
Epidemiological profile of tobacco users attending a tobacco cessation centre at Puducherry, India
S Saravanan, Kuppusamy Rajagopal Lenin
Department of Public Health Dentistry, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry, India
|Date of Submission||26-Jun-2021|
|Date of Decision||17-Aug-2021|
|Date of Acceptance||27-Dec-2021|
|Date of Web Publication||25-Feb-2022|
Department of Public Health Dentistry, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry - 605 006
Source of Support: None, Conflict of Interest: None
Background: Tobacco is a major health burden and an effort has been made to help users to quit tobacco by establishing a tobacco cessation centre in our Institution. A knowledge on the extent of distribution of tobacco use across the various sub-groups of the users would provide clues to behavioural patterns. Objective: To describe the epidemiological profile of tobacco users and to provide a baseline data about the attendees of the cessation centre. Materials and Methods: The data for the present descriptive evaluation were collected by reviewing of case records of participants enrolled from April 2014 to March 2015. Data on demographic characteristics, tobacco use details, substance use details and geographic profile were evaluated. Descriptive statistics were used to present the data using number and percentage. Results: Of the 621 current tobacco users, 95.5% were of male gender. Most participants were married (79.4%), literates (84.9%) and were in the fourth decade of life. 78.1% were exclusive Smokers, 18.2% were exclusive Smokeless tobacco (SLT) users and 3.7% were dual form users. “Peer pressure” was the major reason for initiation of the habit. “Cigarette” was used by 65% of the Smokers and “Betel quid with tobacco” was used by 36.6% of the SLT users. 86.1 and 13.9% of the Puducherry residents were smokers and SLT users respectively. “Oral potentially malignant disorders” were noted in 8% of the users. Conclusion: The observations of the present evaluation provide a baseline data which may serve as a starting point for future epidemiological enquiry.
Keywords: Cigarette smoking, smokeless tobacco, smoking cessation, tobacco, tobacco use cessation
|How to cite this article:|
Saravanan S, Lenin KR. Epidemiological profile of tobacco users attending a tobacco cessation centre at Puducherry, India. J Indian Assoc Public Health Dent 2022;20:69-74
| Introduction|| |
Tobacco is a major global health burden and the projection of the World Health Organization (WHO) that by 2030, there will be more than 8 million deaths every year and more than 80% of the tobacco deaths will be in developing countries and one billion estimated deaths during the 21st century is of a serious concern.
An effort has been made to offer help to quit tobacco and create awareness in the community by establishing a tobacco cessation centre (TCC) in our Institution on January 31, 2014. The centre functions on a daily basis as a routine oral health care service. The cessation service (behavioural counselling) provided was based on the approach described in the training manual developed by the Ministry of Health and Family Welfare, Government of India, and WHO-Regional Office for South-East Asia.
One of the important aspects of health care system is to have a basic data about patients attending the health care services, which would help the researchers to study the disease patterns and illness and thereby formulate new strategies to improve health care. Providing baseline data would help to identify the high-risk groups, elicit regional or national variations and thereby help the policy makers to make changes in health policies or priorities.
Hence, a knowledge on the extent to which tobacco use is distributed across various sub-groups of the users would provide clues to behavioural differences that exist in this part of the country due to various roles in social setting. Also, in accordance with one of the objectives of TCC, as per the operational guidelines 2018, the present evaluation is undertaken with the objectives to evaluate the epidemiological profile and to provide a baseline data about tobacco users attending the TCC.
| Materials and Methods|| |
A retrospective research design was used in this descriptive evaluation. The TCC, Department of Public Health Dentistry, Mahatma Gandhi Postgraduate Institute of Dental Sciences (MGPGI), Puducherry was the study setting. All the participants who attended the tobacco cessation counselling service during the period April 2014–March 2015 were considered for evaluation. Those participants who currently use tobacco in any form and attended the cessation service were included in the evaluation. Thus, a total of 621 current tobacco users aged 18–85 years formed the study participants.
The data for the present evaluation were collected from the existing case records of participants which are available at the TCC, MGPGI. Demographic characteristics (such as gender, age, education status, marital status and geographic area), tobacco use details (such as type, frequency, family history and reason for initiation), information on substance use (alcohol and frequency of tobacco use during alcohol intake) and geographic region wise tobacco use were considered as study variables. Data on oral health were also evaluated.
Descriptive statistics such as number and percentage were used to present the data.
| Results|| |
About 621 current tobacco users participated in the cessation counselling at the TCC between April 2014 and March 2015. In the present evaluation, it has been observed that male and female tobacco users constitute 95.5 and 4.5% respectively [Table 1].
|Table 1: Demographic profile of tobacco users attending the tobacco cessation centre|
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With regard to age, most of the tobacco users were in the age group of 31–40 followed by 41–50-and 21–30-year age groups constituting three-fourths of the attendees. Gender wise evaluation recorded a greater number of participants in the age group of 31–40 years in both the gender, as indicated in [Table 1].
When the education status is analyzed, nearly 85% of the tobacco users were literates in the current evaluation. Gender wise analysis depicts that 87.7% of the male tobacco users were literates whereas 75% of the female users were illiterates.
Regarding the marital status, it is evident that the number of married subjects were higher (493, 79.4%) than the other groups in the marital status. The same pattern is observed in both the genders.
More than half (51%) of the attendees were Puducherry residents, nearly 47% were from the neighbourhood of Tamil Nadu and less than 2% were north Indians which includes the Indian states of Odisha, West Bengal and Bihar. One female attendee was a French national [Table 1].
Majority (78.1%) of the tobacco users were exclusive Smokers. 18.2% were exclusive smokeless tobacco (SLT) users and 3.7% constitute the dual form users. Gender wise analysis showed that 81.6% of the male tobacco users were exclusive smokers. Except for one female smoker (French national), all the female attendees were SLT users (96.4%) as shown in [Table 2].
|Table 2: Tobacco and substance use profile of tobacco users attending the tobacco cessation centre|
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Family history of tobacco use was observed in 49.8% of the participants in the present evaluation. Among the male participants 48.4% reported a family history while female participants documented a very high percentage of 78.6% [Table 2].
To reason out the habit initiation, majority (59.7%) of the attendees reported “peer pressure” as the reason for tobacco initiation. Whereas “no reason” was reported by 18.5% of the participants. Nearly 18% of the female tobacco users started the habit for “relieving tooth ache” [Table 2].
The dual form users were categorized as Smokers and SLT users based on their predominant use of tobacco type. Thus, the Smokers (498) constitute 80.2% and SLT users (123) constitute 19.8% in the present evaluation. Nearly one-third (32.7%) of the men were consuming Smoked form of tobacco (cigarette/bidi) 10 times or more per day and 50% of the women were using some form of SLT 5 times or more per day. Smoking was exclusively a male lifestyle except for one female user, a foreign national [Table 2].
Analysis of the various use of tobacco products among the 498 Smokers revealed that 324 (65%), 107 (21.5%) and 67 (13.5%) were Cigarette, Bidi and dual form users respectively. Out of 123 SLT users, 45 (36.6%), 44 (35.8%), 16 (13%), 14 (11.4%) and 4 (3.2%) were Betel quid with tobacco, Khaini, Plain tobacco, Gutkha and combined form users respectively.
Alcohol habit was found to be exclusively a male lifestyle. 357 (60.2%) of the male tobacco users reported the habit of consuming alcohol. An increase in the frequency of tobacco use was observed in 204 (57.1%) users during alcohol consumption [Table 2].
Further, analysis of the alcohol habit among male tobacco users in terms of Smokers and SLT users revealed that 307 (61.8%) of the Smokers and 50 (52.1%) of the SLT users were having the habit of consuming alcohol on daily/weekly/monthly basis. An increased frequency of tobacco use during alcohol intake was observed in 185 (60.3%) of the Smokers and 19 (38%) of the SLT users who consume alcohol.
The geographic region wise data analysis in the present evaluation depicts the following as in [Table 3]:
|Table 3: Geographic profile of tobacco users attending the tobacco cessation centre|
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- 86.1% and 13.9% of Puducherry residents were Smokers and SLT users respectively
- Among the Tamil Nadu residents, 75.1% and 24.9% were Smokers and SLT users respectively
- Other state residents depict a reverse pattern with 60% and 40% as SLT users and smokers respectively
- 88.6% and 80% of the male tobacco users of Puducherry and Tamil Nadu regions used Smoked form of tobacco respectively
- 100% of the female tobacco users of Puducherry and Tamil Nadu regions used SLT form.
The oral health profile of tobacco users mainly revealed that nearly half (47.2%) of the users had dental caries, more than three-fourths (77%) of the users had periodontal disease, 8% of the users had oral potentially malignant disorders and one female tobacco user had malignancy [Table 4].
|Table 4: Oral health profile of tobacco users attending the tobacco cessation centre|
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| Discussion|| |
In the present evaluation, of the 621 subjects who attended the tobacco cessation counselling services, 95.5% were male subjects indicating that gender plays an important role in predicting tobacco use. A similar pattern of gender variation was noted among the attendees at cessation centres in Bangalore (97%), Delhi (97.3%) and other centres elsewhere in India (92.2%).
The National Tobacco Quitline Services at Delhi recorded a highest percent of male callers (97.8%) of the total registered 5179 callers. Moreover, the secondary analysis of GATS India 2016–2017 data revealed that males are more likely to use tobacco as compared to females.
On evaluating the age groups, the highest number of attendees were recorded between the ages 31 and 40. This strengthens the findings of one of the earlier studies.
An overall evaluation of the education status revealed that majority (84.9%) of tobacco users were literates. This implies that the literates are 5.6 times more likely to use tobacco than the illiterates. The present observation is in accordance with the reports of clinic and telephone-based cessation services,,, and community-based study. Whereas the reverse trend was noticed in one of the earlier studies reported in the year 2004 which analyzed the data of National Family Health Survey 1998–1999. It is evident from the above literature review that tobacco usage has become a feature that is fairly more common among the literates than the illiterates in the past two decades. This phenomenon requires further studies.
Analysis of marital status finds that 79.4% of the attendees were married. This finding fits within the range of other studies,,, and indicates that “every eighth tobacco user is married” which is consistent with the GATS India 2016–2017 report where 83.6% of the tobacco users were married as calculated from the data presented in an earlier study. However, further researches may shed light to know why married individuals consume more tobacco than others.
Regarding the type of tobacco use, majority (78.1%) were Smokers in the present evaluation which is consistent with the earlier studies., Dual forms of tobacco use were noted in 3.7% which is in line with the reports of GATS India 2016–2017 (3.4%).
About half of the tobacco users reported a history of family member/members using tobacco. This is relatively low as compared to other studies.,, Family history of tobacco use actually matters as it influences the tobacco users and nonusers to perceive that tobacco usage is socially accepted and harmless. Hence, it is a significant factor for tobacco usage.,
Majority (59.7%) of the attendees reported “peer pressure” as the reason for habit initiation and this is consistent with the earlier studies.,,, Such a phenomenon exists for all the ages and finds an important role as a predictor.
On analyzing the various tobacco products used, it was found that “cigarette” and “betel quid with tobacco” were the two most commonly used tobacco products in the present evaluation. This is in agreement with GATS India 2016–2017 report for Puducherry.
Alcohol habit was found to be exclusively a male lifestyle and 60.2% of the male tobacco users documented the habit of consuming alcohol, which is almost similar to the findings of earlier studies., The observation that “three in every five alcohol users reported an increase in the frequency of tobacco use during alcohol consumption” indicates that alcohol habit is a potential triggering factor to elevate tobacco usage, and vice versa and impede tobacco cessation.
The concurrent alcohol and tobacco use significantly enhances the risk of mouth and throat cancers as compared to individual risks apart from other health hazards. Hence, policy makers should come out with a “comprehensive prevention plan” including other addictive substance use.
It is evident from the geographic region wise analysis that Smoked tobacco is widely used than SLT among male gender and Smokeless form is preferred by the female gender in Puducherry and Tamil Nadu regions in India. Whereas majority of the attendees of north Indian residence (Odisha, West Bengal and Bihar) reported smokeless form as their choice. This pattern of geographic variation is perfectly in agreement with the findings of the survey report on consumption of tobacco in India (1993–1994) by National Sample Survey Organization wherein it is stated that “Smoking was the most common form of tobacco consumption among males in all major states of India except in Bihar, Maharashtra and Orissa. In Kerala and Tamil Nadu, chewing of tobacco was, in fact, more widespread among females. Whereas in Bihar, the habit of chewing tobacco was largely a male preserve”. This indicates the existence of some strong socio-cultural factors that control the geographic variations in tobacco use in India and hence the pattern remains unchanged for the past three decades. Further studies on this phenomenon would give a better insight of the pattern.
Oral potentially malignant disorders were noted in 8% of the tobacco users, of which Leukoplakia was found to be higher followed by Oral submucous fibrosis and Erythroplakia, which is in agreement with one of the earlier studies.
Strengths and limitations
The present evaluation provides a baseline data and an epidemiological profile of tobacco users attending the TCC in this part of the country. It has some limitations too. The attendees were mostly the patients accessing the hospital for dental treatments and tobacco cessation was not their primary concern. As this is a hospital-based study, the findings cannot be generalized. Also, variables like income, occupation were not considered in this evaluation which would give further insight about the tobacco use profile. Nevertheless, the present evaluation is consistent with other centre/hospital, community, telephone based studies and Nationwide reports and it provides the clues and the scope for future researches.
| Conclusion|| |
The present evaluation provides a baseline data and an epidemiological profile of tobacco users attending the TCC functioning in the department of Public Health Dentistry, MGPGI, Puducherry, South India. The observations recorded in this evaluation may serve as a stimulus to further studies. The highlights of the present evaluation are:
- 95.5% of the tobacco users attending the TCC were of male gender
- 78.1% of the tobacco users were exclusive Smokers, 18.2% were exclusive SLT users, and 3.7% constitute dual form users
- ”Peer pressure” was documented as the reason for tobacco initiation in 59.7% of the attendees
- ”Alcohol habit” was found to be exclusively a male lifestyle
- Among male tobacco users, 61.8% of the Smokers and 52.1% of the SLT users disclosed the habit of consuming alcohol on daily/weekly/monthly basis
- 60.3% of the smokers and 38% of the SLT users with alcohol habit reported an increased frequency of tobacco use while consuming alcohol
- ”Cigarette” was used by 65% of the smokers and “Betel quid with tobacco” by 36.6% of the SLT users exclusively
- 86.1% and 13.9% of the Puducherry residents were Smokers and SLT users respectively
- 75.1% and 24.9% of the Tamil Nadu residents were Smokers and SLT users respectively
- ”Oral potentially malignant disorders” accounted for 8% of the tobacco users attending the TCC.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
World Health Organization. WHO Report on the Global Tobacco Epidemic, 2008: The MPOWER Package. Geneva: World Health Organization; 2008.
Directorate General of Health Services. Manuals for Training in Cancer Control. Manual for Tobacco Cessation. New Delhi: Ministry of Health and Family Welfare, Government of India; 2005.
World Health Organization Regional Office for South-East Asia. Helping People Quit Tobacco-a Manual for Doctors and Dentists. New Delhi: WHO-SEARO; 2010.
Directorate General of Health Services. Establishment of Tobacco Cessation Centres in Dental Institutes-An Integrated Approach in India-Operational Guidelines. New Delhi: Ministry of Health and Family Welfare, Government of India; 2018.
D'Souza G, Rekha DP, Sreedaran P, Srinivasan K, Mony PK. Clinico-epidemiological profile of tobacco users attending a tobacco cessation clinic in a teaching hospital in Bangalore city. Lung India 2012;29:137-42.
Kumar R, Goel N, Kumar S, Kushwah AS, Vijayan VK. Epidemiological profile of tobacco users at tobacco cessation Centre: An Indian experience. Indian J Chest Dis Allied Sci 2016;58:93-7.
Varghese C, Kaur J, Desai NG, Murthy P, Malhotra S, Subbakrishna DK, et al.
Initiating tobacco cessation services in India: Challenges and opportunities. WHO South East Asia J Public Health 2012;1:159-68.
Ruhil R. Socio-demographic determinants of tobacco use in India: Risks of risk factor-an analysis of global adult tobacco survey India 2016-17. SAGE Open 2019;2:1-10.
Kumar R, Saroj SK, Kumar M, Mahakud GC. Demographic profile, smoking cessation interventions and continuous abstinence of tobacco users at 2 years. Indian J Chest Dis Allied Sci 2019;61:31-7.
Goswami A, Reddaiah VP, Kapoor SK, Singh B, Dwivedi SN, Kumar G. Tobacco and alcohol use in rural elderly Indian population. Indian J Psychiatry 2005;47:192-7.
] [Full text]
Subramanian SV, Nandy S, Kelly M, Gordon D, Davey Smith G. Patterns and distribution of tobacco consumption in India: Cross sectional multilevel evidence from the 1998-9 national family health survey. BMJ 2004;328:801-6.
Ray CS, Pedneker MS, Gupta PC, Travers MB, Quah AC, Fong GT. Social influence on adult tobacco use: Findings from the international tobacco control project India, Wave 1 survey. WHO South East Asia J Public Health 2016;5:123-32.
Tata Institute of Social Sciences (TISS), Mumbai and Ministry of Health and Family welfare, Government of India. Global Adult Tobacco Survey GATS 2 India 2016-17; 2017.
Ibrahim IKAL, Alshammari AF, Alshammari MF, Alqunun AM, Almuhaihi KH, Altamimi AR, et al.
Behavioral factors influencing tobacco smoking initiation and quitting in Saudi Arabia. MOJ Public Health 2017;5:10-5.
Malhotra S, Malhotra A, Kakkar N, Das PP, Singh J. The clinical and demographic profile of nicotine users among children and adolescents. Ger J Psychiatry 2009;12:14-8.
Imtiaz D, Kandpal SD, Juyal R. A study on reasons for initiation and frequency of smoking among rural population in Dehradun district of Uttarakhand. Ntl J Community Med 2016;7:298-301.
Pooja, Nebhinani M, Rani R. Tobacco chewing habits and barriers in cessation among tobacco users: A survey from Western Rajasthan, India. Int J Community Med Public Health 2020;7:3617-22.
Ukwayi JK, Eja OF, Unwanede CC. Peer pressure and tobacco smoking among undergraduate students of the University of Calabar, Cross River State. Higher Educ Stud 2012;2:92-101.
Tata Institute of Social Sciences (TISS), Mumbai and Ministry of Health and Family welfare, Government of India. Global Adult Tobacco Survey GATS 2 (Puducherry) India 2016-17. Available from: http://www.tiss.edu/uploads/files/32_pd.pdf
. [Last accessed on 2021 May 26].
Sujatha D, Hebbar PB, Pai A. Prevalence and correlation of oral lesions among tobacco smokers, tobacco chewers, areca nut and alcohol users. Asian Pac J Cancer Prev 2012;13:1633-7.
Friedman GD, Tekawa I, Klatsky AL, Sidney S, Armstrong MA. Alcohol drinking and cigarette smoking: An exploration of the association in middle-aged men and women. Drug Alcohol Depend 1991;27:283-90.
Verplaetse TL, McKee SA. An overview of alcohol and tobacco/nicotine interactions in the human laboratory. Am J Drug Alcohol Abuse 2017;43:186-96.
National Institute on Alcohol Abuse and Alcoholism. Alcohol Alert No. 39, Alcohol and Tobacco; 1998.
National Sample Survey Organization. Consumption of Tobacco in India, 1993-94, Report No. 427. Department of Statistics, Government of India; 1994.
[Table 1], [Table 2], [Table 3], [Table 4]