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ORIGINAL ARTICLE
Year : 2017  |  Volume : 13  |  Issue : 3  |  Page : 576-579

Prevalence of tobacco in Darbhanga district: A hospital-based cross-sectional study


1 Department of Oral Medicine and Radiology, Mithila Minority Dental College and Hospital, Darbhanga, Bihar, India
2 Department of Periodontology, Mithila Minority Dental College and Hospital, Darbhanga, Bihar, India
3 Department of Oral and Maxillofacial Pathology, Mithila Minority Dental College and Hospital, Darbhanga, Bihar, India

Date of Web Publication31-Aug-2017

Correspondence Address:
Jatin Gupta
Department of Oral Medicine and Radiology, Mithila Minority Dental College and Hospital, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.192793

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 > Abstract 


Introduction: Chewing tobacco, smoking, and consumption of alcoholic beverages have become common social habits in India. No study has been conducted so far in this part of Bihar regarding the prevalence of tobacco. The aim of this study was to estimate the prevalence of tobacco use, its influences, triggers, and associated oral lesions.
Materials and Methods: A hospital-based cross-sectional study was conducted. Patients who consume tobacco in any form were selected and were interviewed through a pretested structured questionnaire in relation to their tobacco habits, its influences, and triggers. In addition, clinical examination was carried out to check for any tobacco-related oral lesions.
Results: The overall prevalence of tobacco use was 16.69%, out of which 14.48% were males and 2.21% were females. The most affected age group was from 19 to 50 years. 13.45% were below 18 years of age. 43.40% males and 77.42% females having the tobacco habit were illiterates. The majority of individuals were addicted due to peer pressure and friends, some acquired it, due to loneliness, stress, and for adapting themselves in the work place. Females frequently used smokeless for cleaning teeth. The most common oral mucosal lesion in both males (53.26%) and females (18.55%) was tobacco hyperkeratosis.
Conclusion: The present study reflects the high prevalence rates of tobacco use among various sections of society. Apart from mass against tobacco products, authorities should focus on strict enforcement of law and promote research for creating new and harmless replacement products.

Keywords: Oral mucosal lesions, prevalence, tobacco chewing, tobacco smoking, triggers


How to cite this article:
Gupta J, Wesly SJ, Gupta K. Prevalence of tobacco in Darbhanga district: A hospital-based cross-sectional study. J Can Res Ther 2017;13:576-9

How to cite this URL:
Gupta J, Wesly SJ, Gupta K. Prevalence of tobacco in Darbhanga district: A hospital-based cross-sectional study. J Can Res Ther [serial online] 2017 [cited 2020 Jun 4];13:576-9. Available from: http://www.cancerjournal.net/text.asp?2017/13/3/576/192793




 > Introduction Top


Tobacco has been used in both smoke and smokeless forms and its use in children and adolescents are reaching pandemic levels. The studies have shown that around 82,000–99,000 children/adolescents get addicted to this habit every day.[1] The number of deaths associated with these products is also on a rising trend. This figure is expected to rise to about 8.4 million by the year 2020, with 70% of those deaths occurring the developing countries.[2] Smoking and smokeless form of tobacco use is common in India. It is estimated that more than 150 million men and 44 million women in India use tobacco in various forms.[3] Smoking, drinking, and chewing have been positively associated with oral lesions such as oral submucous fibrosis (OSF), leukoplakia, and oral lichen planus, which has the potential for malignant transformation.

Tobacco use is influenced by various factors, such as individual attitudes, social acceptability, availability, advertising campaigns, etc. Tobacco use in India differs from that of the globe since the dominant form of tobacco used globally is the cigarette; however, in India, only 20% of the tobacco is consumed as cigarettes, 40% is consumed as bidi, and the rest in the smokeless forms.[4]

Dentists come across patients with tobacco habits and are in a stronger position compared to other medical practitioners to counsel the patients regarding the adverse effects of tobacco. Very few hospital-based studies have been conducted to assess the prevalence of tobacco use and their epidemiological and behavioral patterns among patients with dental needs. Therefore, this study was conducted to evaluate the prevalence of tobacco use among the patients in Darbhanga and to elucidate the associated factors.


 > Materials and Methods Top


The hospital-based cross-sectional study was conducted from September 2014 to February 2015. All the 5600 patients who reported to the Department of Oral Medicine and Radiology were questioned to select the patients who consume tobacco in any form. The 935 patients, who agreed to have the habit of tobacco smoking and/or smokeless, were included in the study after obtaining a written informed consent. Trained dental surgeons interviewed the patients through a pretested structured questionnaire to collect data on the age, sex, education, socioeconomic status, and marital status, form of tobacco, duration and frequency of consumption, reason for initiation, and triggers for tobacco use. Further, the patients were clinically examined for any tobacco-related oral lesions. Any respondent using tobacco (up to 5 times/day) was categorized as a light tobacco user, “between 6 and 20 times/day” as a moderate tobacco user and “>20 times/day” was classified as a heavy tobacco user.[5]

Statistical analysis

The data collected was tabulated and analyzed using Microsoft Excel. Chi-square test was used to evaluate the presence of statistically significant difference between the gender and the variable characteristics (age, educational status, occupational status, etc.) under the study.


 > Results Top


The overall prevalence of tobacco use was 16.69%, out of which 14.48% were males, and 2.21% were females. Of the total 935 individuals included in the study, 811 were males, and 124 were females. In both the sexes, the most affected age group was from 19 to 50 years. In addition, 13.45% involved in this habit were below 18 years of age [Table 1].
Table 1: Distribution of tobacco users by age and sex

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The 43.40% males and 77.42% females with habit were illiterate although 56.60% males were literate and 22.58% females were literate [Table 2].
Table 2: Education status of tobacco users

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The majority of the individuals were addicted to this habit due to peer pressure and friends. Some acquired the habit due to loneliness, stress, and for adapting themselves in workplace. Females are more frequently using this for cleaning teeth, but 16.13% have adapted this from friends also [Table 3].
Table 3: Reason for initiation for tobacco use

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Tobacco hyperkeratosis was the most frequently found oral lesion in both males (53.26%) and females (18.55%). Other lesions were also seen [Table 4].
Table 4: Lesion associated with the tobacco use

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Among the total 811 male individuals included in the study, moderate users (68.22%) were higher in numbers than light users (29.63%) while severe users were only 2.15% [Table 5].
Table 5: Category of tobacco users-male

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Among the total 124 females included in the study, 90.62% were light tobacco users while others were moderate/severe users [Table 6].
Table 6: Category of tobacco users-female

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In this study, the use of smokeless tobacco (75%) was more common than the smoking (25%) in males, whereas all females were used smokeless form of tobacco [Table 7].
Table 7: Type of tobacco used

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Among males commonly used smokeless form of tobacco was khaini - 38.58% and gutka - 48.35%. In smoking form, cigarette smokers were 4.32% while bidi smokers were 8.75% [Table 8].
Table 8: Tobacco product used

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 > Discussion Top


The overall prevalence of tobacco use in our study was 16.69% which is lower than that in Karnataka (29.6%), Uttar Pradesh (34.6%),[6] and as well as national average of 30.2%.[7] In this study, most of the males and females had very less income which is consistent with the study of Kinra et al.[8],[9] and the overall national situation;[7] thus, supporting the finding that tobacco use is higher among individuals with lower standards of living. In our study, overall education attainment of patients was low which supports the finding that tobacco use is higher among individuals with lower levels of education as also evidenced by various other studies.[3],[7]

In this study, the user of smokeless tobacco (75%) was more common than the smoking from (25%) in males. In our study, all females were using smokeless form of tobacco, “gul” in particular. Indian Government has banned smoking in public places, however, has imposed no ban on smokeless products, which probably could be a reason why smokeless form is more prevalent in this sample studied. In our study, men practiced smoking as well as tobacco chewing, whereas women only chewed or applied tobacco for cleaning of teeth. Although smoking by women is not well accepted in the Indian Society, consumption of smokeless tobacco is well accepted, and the use of gul is a very common practice in Bihar and Bangladesh.

Among men, the most commonly used smokeless form of tobacco was khaini (38.58%) “gutka” was the second most commonly used smokeless product and its increasing use may be contributed to the advertising and the marketing strategies of manufacturers. Khaini is less expensive compared to gutka; hence may be used by more number of people. In our study, among males, cigarette smokers (4.32%) were less than bidi smokers (8.75%).

In this study, among males, moderate tobacco users (68.22%) were higher in number than light users (29.63%), which is in contrast to the study of Goswami et al.[10] (light and moderate tobacco users were equal). In our study, females were mainly light tobacco users (90.62%) which are consistent with the study of Goswami et al.[10] (71.8%). Since friends and stress were most common reasons for tobacco use initiation in males; and cleaning of teeth the important cause in females, these factors should be kept in mind while designing the interventional strategies. Counseling of patients on how to avoid tobacco in the presence of the triggering factors should be important aspects of tobacco cessation programs. The prevalence of oral soft tissue lesions in our study was 6.14%, which is more than reported by Saraswathi et al.[11] (4.1%). In our study, all lesions were more prevalent in men than women, which is consistent with the study by Saraswathi et al.[11] In our study, the most common oral lesion in both genders was tobacco hyperkeratosis. In males, OSF was 3.33%, leukoplakia was 2.96%, carcinoma was 3.95%, and others were 6.04%, whereas 9.87% showed no oral lesions.

The limitation of this study is self-reporting by the patients from whom the information regarding their tobacco habits was collected and hence, there are chances of underreporting.


 > Conclusion Top


The present study clearly reflects the continued high prevalence rates of tobacco use among the various sections of society. Mass advertisements against tobacco products and certain legal steps taken by the governments do not seem to be very effective and have been largely unable to cease the consumption of tobacco products by the people. This failure also points toward the facts that deaddiction is a difficult task which not only requires motivation and self-control but also time, money, and other resources. Recently, certain new replacement products have been introduced in the market which are harmless and can also curb the craving for tobacco. Apart from mass advertisements against tobacco products, authorities should focus on strict enforcement of law and promote research for creating new and harmless replacement products.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

1.
Jha P, Chaloupka FJ, editors. Curbing the Epidemic: Governments and the Economics of Tobacco Control. Washington, D.C.: The World Bank; 1999.  Back to cited text no. 1
    
2.
Ansari ZA, Bano SN, Zulkifle M. Prevalence of tobacco use among power loom workers – A cross-sectional study. Indian J Community Med 2010;35:34-9.  Back to cited text no. 2
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Rani M, Bonu S, Jha P, Nguyen SN, Jamjoum L. Tobacco use in India: Prevalence and predictors of smoking and chewing in a national cross sectional household survey. Tob Control 2003;12:e4.  Back to cited text no. 3
    
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Kramer IR, Lucas RB, Pindborg FF, Sobin LH. WHO collaborating centre of oral pre-cancerous lesion, definition of leukoplakia and related lesions: An aid to studies on oral pre-cancer. Oral Surg Oral Med Oral Pathol 1978;46:568-9.  Back to cited text no. 4
    
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Gupta PC, Mehta FS, Daftary DK, Pindborg JJ, Bhonsle RB, Jalnawalla PN, et al. Incidence rates of oral cancer and natural history of oral precancerous lesions in a 10-year follow-up study of Indian villagers. Community Dent Oral Epidemiol 1980;8:283-333.  Back to cited text no. 5
    
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Chouwdhary K, Prabhakar A, Prabhakaran P, Prasad A, Singh K, Singh A. Final Report of the Study by the Indian Council of Medical Research and the WHO South East Asian Regional Office; Prevalence of Tobacco Use in Karnataka and Uttar Pradesh in India. New Delhi; 2001.  Back to cited text no. 6
    
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Neufeld KJ, Peters DH, Rani M, Bonu S, Brooner RK. Regular use of alcohol and tobacco in India and its association with age, gender, and poverty. Drug Alcohol Depend 2005;77:283-91.  Back to cited text no. 7
    
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Kinra S, Bowen LJ, Lyngdoh T, Prabhakaran D, Reddy KS, Ramakrishnan L, et al. Sociodemographic patterning of non-communicable disease risk factors in rural India: A cross sectional study. BMJ 2010;341:c4974.  Back to cited text no. 8
    
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Kasat V, Joshi M, Somaundaram KV, Viragi P, Dhore P, Sahuji S. Tobacco use, its influences, triggers, and associated oral lesions among the patients attending a dental institution in rural Maharashtra, India. J Int Soc Prev Community Dent 2012;2:25-30.  Back to cited text no. 9
    
10.
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.  Back to cited text no. 10
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11.
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. 11
[PUBMED]  [Full text]  



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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