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ORIGINAL ARTICLE
Year : 2017  |  Volume : 13  |  Issue : 2  |  Page : 230-234

Patterns of tobacco usage among subjects with potentially malignant oral lesions or conditions in Chennai city: A comparative study


1 Department of Public Health Dentistry, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
2 Department of Public Health Dentistry, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India

Date of Web Publication23-Jun-2017

Correspondence Address:
Mohammed Junaid
Room No. 4, Department of Public Health Dentistry, Meenakshi Ammal Dental College and Hospital, Chennai - 600 095, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.184519

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 > Abstract 

Objective: To determine the patterns of tobacco usage among subjects with potentially malignant oral lesions or conditions through a comparative study design.
Methods: The study was carried out in a span of 2 months on a sample of 120 subjects; 60 in case group (30 subjects with leukoplakia and oral submucous fibrosis [OSMF], respectively) and 60 subjects in control group (30 current smokers and current chewers, respectively), attending the tobacco cessation clinic at a private dental college hospital in Chennai city. Demographic data, details of tobacco usage, and Fagerstrom nicotine dependence scores (FNTD) were recorded in a prevalidated tobacco cessation intake form.
Results: Cases with leukoplakia had a higher mean FNTD score when compared to the control group (P = 0.0001). The most common form of smokeless tobacco used by case (OSMF) subjects was found to be mawa (53%) significantly higher than the control group (P = 0.05). Mean FNTD scores of mawa users were higher than other tobacco users in both case and control group.
Conclusion: The current study has hence put forth the role of mawa form of tobacco in causation of OSMF at a time when implementation of tougher anti-tobacco laws is the talk of the town.

Keywords: Leukoplakia, mawa, oral submucous fibrosis


How to cite this article:
Junaid M, Periyanan K, Raj A, Madan Kumar P D. Patterns of tobacco usage among subjects with potentially malignant oral lesions or conditions in Chennai city: A comparative study. J Can Res Ther 2017;13:230-4

How to cite this URL:
Junaid M, Periyanan K, Raj A, Madan Kumar P D. Patterns of tobacco usage among subjects with potentially malignant oral lesions or conditions in Chennai city: A comparative study. J Can Res Ther [serial online] 2017 [cited 2019 Nov 13];13:230-4. Available from: http://www.cancerjournal.net/text.asp?2017/13/2/230/184519


 > Introduction Top


Oral lesions such as leukoplakia and oral submucous fibrosis (OSMF) have increased potential of malignant transformation and are positively associated with tobacco use.[1],[2] In India, 35% of its population uses tobacco in either of its forms attracting enhanced usage among its youth.[3],[4] Recently, legislations have been enacted by the union government with certain states banning the sale of selected tobacco products. This initiative is bound to impact the overall pattern of tobacco usage among its users to some extent and on subjects with oral precancer to a larger extent.[3],[4],[5] Thus, the current study was carried out to determine the patterns of tobacco usage among subjects with potentially malignant oral lesions or conditions in Chennai city through a comparative study design.


 > Methods Top


Sample for both case and control group was taken from subjects reporting to the tobacco cessation clinic of a private dental college hospital in Chennai from July to August 2015.

Sample was collected through nonprobability sampling method. Sample size was calculated to be 120 (60 patients in case group and 60 patients in control group) based on the prevalence of disease taken from hospital records and the methodology assessment of study. (Power - 90%, α error - 5%). The case group was further divided into two sub groups (leukoplakia and OSMF) having 30 subjects in each. The control group was also subsequently divided into two groups, current smokers and current chewers without premalignant oral lesions or conditions. This subdivision was made such that the subjects with leukoplakia were compared with current smokers and subjects with OSMF were compared with current chewers only to avoid potential confounding variables. Excluded were those current tobacco users who were both current smokers and chewers.

Ethical clearance was obtained from the Institutional Review Board. Universal precautions were taken. Informed consent was obtained from the patient after describing the study protocol in detail. Demographic details, details of tobacco usage, and nicotine dependence from Fagerstrom's nicotine dependence scale (FNTD) from both the groups were recorded from the subjects using the tobacco cessation clinic intake form validated by the Ministry of Health and Family Welfare, Government of India.[6] American Dental Association Type III examination of the oral cavity was done to assess the severity of oral precancerous lesion or condition in the case group based on which was noted in the intake form itself.

Statistical analysis

Statistical analysis was carried out with SPSS software Version 16 (IBM. Corp., Chicago, IL, USA). Normality of quantitative data collected was assessed using Shapiro–Wilk's test and was found to be parametric in nature (P > 0.05). Comparison of individual case and control group was done using Chi-square test, Fisher exact test for categorical data, and independent sample t-test for quantitative data to test the level of significance. One-way ANOVA was used to determine the quantitative difference between different forms of smokeless tobacco. P< 0.05 was considered as statistically significant in the present study.


 > Results Top


Assessment in the present study was broadly based on the demographic characteristics, patterns of tobacco usage, and levels of dependence in the leukoplakia group and OSMF group separately.

Leukoplakia group

Demographic characteristics

The study population of both case and control groups were constituted by males. The mean age of subjects in the leukoplakia group (41.63 years) was found be significantly higher than the control group (35.23 years) (P = 0.010). A small percentage of the case group (23.3%) belonged to the migrant population (people from other states) when compared to the control counterparts. While comparing the socioeconomic background, it was noted that a significantly larger proportion of subjects in the case group were either skilled or semiskilled laborers (76.7%) when compared to their control counterparts (P = 0.05). The other demographic characteristics have been demonstrated in [Table 1].
Table 1: Demographic characteristics of leukoplakia group

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Patterns of tobacco usage

Majority of the subjects in case and control group were cigarette users; however, a greater proportion of beedi users (80%) belonged to the case group when compared to the control group (P = 0.08). The mean age of onset of the smoking habit among case group (23.93 years) was found to be significantly lower than the control subjects (28.40 years) (P = 0.001). The mean number of cigarettes or beedi's used by the case group per day (10.7 ± 3.0) was found to be significantly higher than control subjects (5.47 ± 3.31) (P = 0.000). The mean number of years of regular tobacco usage among the case subjects was significantly higher than the control subjects (P = 0.000) [Table 2].
Table 2: Comparison of pattern of tobacco use, nicotine dependence and alcohol usage among case (leukoplakia) and control group

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Alcohol usage

A majority of case subjects consumed alcohol (70%) when compared to their control counterparts (46.7%), with predominant proportion of case group (47.6%) were either daily or regular users of alcohol when compared to the control subjects (P = 0.146) [Table 2].

Levels of dependence

The mean FNTD score in the case group was found to be 7.14 ± 0.87, which was significantly higher than their control counterparts (3.55 ± 0.99) (P = 0.000).

Oral submucous fibrosis group

Demographic characteristics

The study population of both case and control groups were constituted by males. The mean age group of subjects in the OSMF group (30.77 years) was found to be significantly lower than their control group (38.20 years) (P = 0.006). A small percentage of the case group (20%) belonged to the migrant population (people from other states), which was significantly higher than their control counterparts (P = 0.027). The other demographic characteristics have been demonstrated in [Table 3].
Table 3: Comparison of demographic characteristics of case (oral submucous fibrosis) and control group

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Patterns of tobacco usage

Majority of subjects in the case group used mawa form of smokeless tobacco when compared to Betel quid and khaini forms in the control subjects (P = 0.05). Mean age of onset of tobacco use among the case group was lower than that of the control group (P = 0.000). The mean number of sachets used by the case group was found to be significantly higher than the control subjects [Table 4].
Table 4: Comparison of pattern of tobacco use, nicotine dependence and alcohol usage among case (oral submucous fibrosis) and control group

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When evaluating the patterns of usage within the case group, it was noted that the age of onset of tobacco usage among mawa users was significantly lower than the subjects using the other tobacco products (P = 0.001). Frequency of usage of different forms of tobacco in the case group was similar (P = 0.609). Khaini and mawa users had a lower mean duration of usage when compared to subjects with other forms of tobacco [Figure 1].
Figure 1: Comparison of mean Fagerstrom nicotine dependence score of different smokeless form of tobacco in case (oral submucous fibrosis) and control group

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Patterns of tobacco usage based on severity of oral submucous fibrosis

Based on Gupta's classification of severity of OSMF,[7] majority of mawa users (87.5%) had moderate to severe form of the disease and all the paan masala users had least severe form of the disease.(P = 0.0001) [Figure 2].
Figure 2: Patterns of tobacco usage among subjects with different grade of oral submucous fibrosis

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Levels of dependence

The mean FNTD score in the case group (7.83 ± 2.16) was found to be statistically significantly higher when compared to the control group (4.90 ± 1.76) (P = 0.0001).

On individual evaluation of case group, mawa users had the highest mean FNTD score (9.37) followed by Gutkha users. Paan masala users were found to have the least FNTD score among the case subjects (P = 0.0001). The control group also showed a similar trend as the case group with mawa users with having the highest mean FNTD score (7.17).


 > Discussion Top


The present study is one of the first few studies to be carried out on subjects with oral precancerous lesions and conditions after the implementation of the state level ban on the commercial sale of gutkha in Tamil Nadu.

Leukoplakia group

The overall findings in the leukoplakia group are similar to findings of previous studies conducted by Bokor-Brati and Vu Koviæ and Saraswathi et al.[8],[9] The common form of tobacco used in the present study by both case and control group was found out to be cigarette which was found to be similar to the overall findings of the global adult tobacco survey 2009–2010, the difference could be attributed to the urban location of the study.[3] The mean number of cigarette sticks used by subjects in the case group (10.17) of the present study was higher than the national average (6.2) as reported in findings of the global adult tobacco survey 2009–2010.[3]

Oral submucous fibrosis group

International variations

Majority of case subjects in our study chewed mawa (53.3%), which was different from previous international studies carried out in Sudan (Betel-quid), Saudi Arabia (Shammah), and Pakistan (Naswar).[10],[11]

National and local variations

In the present study, a large proportion of mawa users (53.3%) developed the disease, a finding different from a previous study conducted in a South Indian population by Saraswathi et al. and North Indian population by Gupta et al. and Shah and Sharma [9],[12],[13] The proportion of gutkha users was very negligible in the case group which was different from the observation made by Hazarey et al., Patil et al., Vikneshan et al., and Saraswathi et al.[9],[14],[15],[16] Majority in the case group were mawa users (53.3%) which is contrary to the findings of the Global adult tobacco survey of 2009–2010 which reported khaini (12%) as the commonly used form of smokeless tobacco in our country.[3]


 > Conclusion Top


The study although short in stature has shown a shift in trend towards usage of unregulated forms of smokeless tobacco products (mawa). Easy access to youth and clever pricing could be cited as a few reasons for enhanced usage of mawa, thus highlighting the role of this tobacco product in causation of OSMF. More scientific research on this regard is needed and stricter implementation of COTPA should be a norm, so as to prevent the occurrence of oral cancer which is rapidly eating into the youth of our country.

Financial support and sponsorship

The study was supported by a grant from the Indian Council of Medical Research (STS - 2015-04881).

Conflicts of interest

There are no conflicts of interest.

 
 > References Top

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Lim K, Moles DR, Downer MC, Speight PM. Opportunistic screening for oral cancer and precancer in general dental practice: Results of a demonstration study. Br Dent J 2003;194:497-502.  Back to cited text no. 1
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Coelho KR. Challenges of the oral cancer burden in India. J Cancer Epidemiol 2012;2012:701932.  Back to cited text no. 2
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Ministry of Health and Family Welfare Government of India, World Health Organization, Centre for Disease Control. Global Adult Tobacco Survey India Report 2009-10; 2010. p. 26.  Back to cited text no. 3
    
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Ministry of Health and Family Welfare, Government of India. Report on Tobacco Control in India; 2004. p. 6-48.  Back to cited text no. 4
    
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Tamil Nadu, Department of Health and Family welfare. 2013. Food safety and standards Act (Central Act 34 of 2006). Government Gazette No 1418/2013/S1/FSSA.  Back to cited text no. 5
    
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Berwal V, Khangwal M, Solanki R, Khandeparker R, Savant K, Shetye O. Classification systems for oral submucous fibrosis – From past to present: A review. Int J Dent Health Sci 2014;1:900-13.  Back to cited text no. 7
    
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Bokor-Brati M, Vu Koviæ N. Cigarette smoking as a risk factor associated with oral leukoplakia. Arch Oncol 2002;10:67-70.  Back to cited text no. 8
    
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Saraswathi TR, Ranganathan K, Shanmugam S, Sowmya R, Narasimhan PD, Gunaseelan R. Prevalence of oral lesions in relation to habits: Cross-sectional study in South India. Indian J Dent Res 2006;17:121-5.  Back to cited text no. 9
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Patil S, Jaffer M, Anil S. Smokeless tobacco patterns of consumption oral potentially malignant disorders and other oral health issues. J Int Oral Health 2016;8:i-iii.  Back to cited text no. 10
    
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Alsanosy RM. Smokeless tobacco (Shammah) in Saudi Arabia: A review of its pattern of use, prevalence, and potential role in oral cancer. Asian Pac J Cancer Prev 2014;15:6477-83.  Back to cited text no. 11
    
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Gupta S, Singh R, Gupta OP, Tripathi A. Prevalence of oral cancer and pre-cancerous lesions and the association with numerous risk factors in North India: A hospital based study. Natl J Maxillofac Surg 2014;5:142-8.  Back to cited text no. 12
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Shah N, Sharma PP. Role of chewing and smoking habits in the etiology of oral submucous fibrosis (OSF): A case-control study. J Oral Pathol Med 1998;27:475-9.  Back to cited text no. 13
    
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Hazarey VK, Erlewad DM, Mundhe KA, Ughade SN. Oral submucous fibrosis: Study of 1000 cases from central India. J Oral Pathol Med 2007;36:12-7.  Back to cited text no. 14
    
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Patil PB, Bathi R, Chaudhari S. Prevalence of oral mucosal lesions in dental patients with tobacco smoking, chewing, and mixed habits: A cross-sectional study in South India. J Family Community Med 2013;20:130-5.  Back to cited text no. 15
    
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Vikneshan M, Ankola AV, Hebbal M, Sharma R, Suganya M. Patterns of tobacco usage and oral mucosal lesions among industrial workers: A cross sectional study. Austin J Public Health Epidemol 2016;3:1029.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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