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Year : 2018  |  Volume : 14  |  Issue : 2  |  Page : 368-371

Prevalence, knowledge, and attitude of gutkha chewing among school children of Arsikere, India

1 Department of Oral Pathology, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
2 Maithri College of Dentistry and Research Centre, Raipur, Chhattisgarh, India
3 Department of Oral Pathology, College of Dental Sciences, Davangere, Karnataka, India
4 Department of Oral Pathology, Manubhai Patel Dental College, Vadodara, Gujarat, India

Date of Web Publication8-Mar-2018

Correspondence Address:
Dr. Rashmi Metgud
Department of Oral Pathology, Pacific Dental College and Hospital, Airport Road, Debari, Udaipur - 313 024, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-1482.174532

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 > Abstract 

Aims: To assess the prevalence, knowledge, and attitude of gutkha chewing among school children of Arsikere, India.
Materials and Methods: Two thousand school children aged between 10 and 15 years were examined with individual interviews along with a questionnaire to evaluate the presence of betel nut and paan chewing habit in various forms. Children of both sexes were included in the study. Responses of all study population and the association between dependent and explanatory variables were assessed using Chi-square test.
Results: Twenty-eight percent of children had the habit of gutkha chewing, more among boys than girls at the ratio of 4:1 which was statistically significant (P < 0.05). The habit was more common in government school children than private school children; over 70% of children believed that it is a bad habit, but half the study population was not aware of side effects; 30% of children believed that it is not a bad habit and has no side effects.
Conclusion: There is a higher prevalence of gutkha chewing habit in school children who are not aware of the side effects. Children themselves purchase the gutkha and betel nut sachets, hence the Government should ban the sale and purchase by children.

Keywords: Betel nut, gutkha, school children, tobacco

How to cite this article:
Metgud R, Murugesh C J, Shiva Kumar B N, Priya N K, Rashmi P, Naik S, Tak A. Prevalence, knowledge, and attitude of gutkha chewing among school children of Arsikere, India. J Can Res Ther 2018;14:368-71

How to cite this URL:
Metgud R, Murugesh C J, Shiva Kumar B N, Priya N K, Rashmi P, Naik S, Tak A. Prevalence, knowledge, and attitude of gutkha chewing among school children of Arsikere, India. J Can Res Ther [serial online] 2018 [cited 2020 May 31];14:368-71. Available from: http://www.cancerjournal.net/text.asp?2018/14/2/368/174532

 > Introduction Top

Cancer is one of the major threats to Government health in the developed world and increasingly in the developing world. In developed countries, cancer is the second most common cause of death. According to the World Health Report, cancer accounted for 7.1 million deaths in 2003, and it is estimated that the overall number of new cases will rise by 50% in the next 20 years. Tobacco consumption is a major health menace owing to its widespread use particularly among adolescents. Owing to the presence of impressionable, curious minds, and adolescents are highly prone to a number of influences within and outside the home, leading them to experiment with tobacco. The addictive nature of tobacco is potent enough to turn these experimental users to addicts. Tobacco use is unique in terms of its current and projected future impact on global mortality. If the current trend continues, the number of people killed by tobacco use will be more than 10 million annually by the year 2030.[1]

Tobacco use often begins before adulthood. The global youth tobacco survey (GYTS) shows that a disturbingly high number of school children between the age of 13 and 15 years are currently using or have tried tobacco.[2] The risk of developing tobacco-related cancer and chronic heart and lung diseases is greater in young adolescents. The negative health effects associated with smokeless tobacco consumption include oral, pharyngeal, and esophageal cancer,[3] cardiovascular disease,[4] and nicotine addiction.[5] The damaging and harmful effects of tobacco usage on oral health are now well recognized. These include, in particular, a higher prevalence and severity of periodontal diseases and malignancies among users.[6],[7] Other dangers from smokeless tobacco use include the following: Oral leukoplakia,[8],[9] gum recession that results in exposed roots and increased sensitivity to heat and cold, drifting and tooth loss from damage to gingival tissue, abrasion to tooth enamel because of high levels of sand and grit contained in smokeless tobaccos, tooth discoloration, and bad breath.[10],[11] Even experimental use of tobacco in adolescence significantly increases the risk of adult addicting to tobacco as well as the risk of disease and death.[12]

Dentists are expected to be role models to their patients. Dentists are in a unique position to give their patients specific, authoritative information concerning the adverse oral effects of tobacco use as they render frequent dental services.[12] Hence, this study was designed to assess the prevalence, knowledge, and attitude of gutkha chewing among school children of Arsikere, India.

 > Materials and Methods Top

A cross-sectional descriptive study was conducted among the school going children aged 10–15 years attending various schools (Government and private) at Arsikere, India. The study protocol was reviewed by the Institutional Review Board and was granted ethical clearance. An official permission was obtained from the Director of Education, Arsikere. The time and date of the survey were intimated to students well in advance and informed consent was obtained. The procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional or regional) and with the Helsinki Declaration of 1975, as revised in 2000.

A pilot study was carried out among 50 children, 10 and 15 years old from one private and one government school to determine the feasibility of the study. Depending on the prevalence obtained (31%), 95% confidence level, and 10% allowable error, the sample size was determined to be 855 which were rounded off to 1000 each in private and government schools.

The sample frame consisted of middle and high schools in Arsikere, obtained from District Education Office. Study sample was recruited by a two-stage cluster sampling technique. For study purpose, Arsikere city was arbitrarily divided into 4 geographical regions, and schools from each region were randomly selected to obtain the desired sample size, such that there was an equal representation from each of the four zones. Of the total number of government (33) and private schools (59), ten government and fifteen private schools were randomly selected. In the second stage, eligible schoolchildren were stratified according to age and gender and randomly selected in proportion to the total number of 10–15 years old students enrolled in each school to reach the sample of 2000.

A questionnaire with a set of 15 questions was prepared. These close-ended questionnaires covered questions regarding gutkha use, factors leading to its initiation, type of gutkha consumed, attitude toward its use, awareness about health risk and others. The questionnaire was pretested among 25 students, so as to confirm its validity and reliability and to avoid ambiguity. Following the pretest, some modifications in the order of questions and terminologies were made in the final questionnaire. Cronbach's coefficient was found to be 0.78, which showed a high internal reliability of the questionnaire. It was designed in such a way that the procedure should not take more than 10 min for an individual keeping in mind the interest and cooperation of students.

Considering the sensitivity of the issue, the school authorities were requested not to be present in the class during the procedure of filling the questionnaire. The purpose of the study was informed and explained to participants. Students were assured that the information they provided would remain confidential and thus were encouraged to be truthful in their response. The students were instructed to give only one answer for each question, which they felt, was most appropriate.

The data was analyzed using the Statistical Package for Social Sciences version 21.0 software (SPSS Inc, Chicago, IL). Chi-square test was used for statistical analysis. The level of significance was set at 0.05.

 > Results Top

Of the total study population surveyed, 1123 (56.2%) were boys, and 877 (43.8%) were girls. The prevalence of gutkha chewing was observed in 540 (27%) of the study population, 432 (38.5%) boys and 108 (12.3%) girls have tried gutkha chewing once or more before this study [Table 1]. In relation to the type of schools, it was observed that the prevalence was 360 (18%) in government and 180 (9%) in private schools. The maximum prevalence was found in the age group of 14–15 years.
Table 1: Prevalence of gutkha chewing among the study population

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Various reasons were attributable for trying gutkha, among which curiosity ranked highest (25%) closely followed by peer pressure (22%). About 20% subjects tried gutkha chewing to impress the opposite sex and 10% to avoid bad breathe. A few attempted it to show that they have grown up or merely as an extension of family practice which reflected a significant effect of parental use [Figure 1].
Figure 1: Percentage distribution of responses regarding the reasons for gutkha use

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The preferred time for its use was mainly found to be after school hours (38%) followed by play hours (30%) and on the way to school (22%). Minimum use was during school hours (10%). This was found to be statistically significant (P ≤ 0.05) [Figure 2].
Figure 2: Percentage distribution of preferred time for gutkha use

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Over 70% believed that it is a bad habit among which only half of the study population was aware of the health hazards inflicted by gutkha chewing.

 > Discussion Top

This study provides an overview of gutkha use among school children of Arsikere and enables us to determine the prevalence of gutkha chewing, the age of its initiation, knowledge about ill effects, and attitude toward the same so that anti-tobacco strategies can be implemented on the basis of these determinants. The study sample consisted of school children from both government and private schools to have a representation of children from all the social, economic, and cultural communities.

Nearly, 432 (38.5%) boys and 108 (12.3%) girls in school children of Arsikere were experimental users, i.e., who have tried chewing gutkha at least once or more. It means the proportion of experimenting was higher in boys than girls. Boys in Indian culture enjoy a higher level of freedom regarding their individual behavior than girls both in the family and society.[13] The recent study from Turkey also showed that boys were more likely to use gutkha or tobacco as compared to girls.[14] This result is significantly less as compared to GYTS carried out at Romania in 2003, which showed that 56.7% of 13–17 years olds have experimented with tobacco[15] and also in Serbia and Hungary[16] which may be related to the cultural and geographical differences between these countries.

The most popular form, among adolescents who had experimented tobacco products, has been smokeless tobacco (Pan Masala, Gutkha, etc.) (66.7%). This may be because of lack of knowledge of the ingredients and health hazards of pan masala, gutkha, and confusion of these products as mouth freshener or processed betel nut. Many use smokeless tobacco to “TREAT” a toothache, headache, and stomachache. This false impression promotes tobacco use among youths.[17] In addition, smokeless tobacco products were convenient to hide from their parents and teachers, and they are less expensive, easier to use, and easily available.

The common age of first experimenting with gutkha was 14–15 years. Curiosity and peer pressure were the main reasons for experimenting with gutkha during adolescence. The relationship with the peer group becomes stronger than a family member, and the young people are influenced more by the habits of their friends. Imitating the behavior of friends is a common practice among adolescents (Erikson theory).[12],[18] However, other studies have reported somewhat similar observations showing initiation of gutkha use at the age of 13–14 years in the most of the countries.[19]

The result also shows a positive correlation between parental use and adolescents experimenting with the gutkha product. Gutkha use by family members is likely to influence adolescents; they are more likely to perceive gutkha use as a positive and acceptable behavior. Adolescent students who live in homes where the members regularly use tobacco were more likely to use gutkha than those not exposed to these products at home. This has been reflected in other studies conducted around the world showing that the parents consumption at home had a greater impact on their children to experiment gutkha product as it grants them easy access.[20],[21]

When they were asked about the knowledge regarding ill effects of gutkha chewing, it was low. Many of them also showed a negative attitude toward stopping chewing. These significant percentages clearly show the negative attitude toward chewing which is alarming. Hence, it is the right time to identify the appropriate age group and start the implementation of anti-tobacco strategies.

 > Conclusion Top

Gutkha chewing prevalence among school children was high that needs to be dealt with a systematic preventive approach. The study has also managed to contribute additional information regarding attitude toward chewing gutkha which is of great concern to us. Comprehensive tobacco education and gutkha cessation programs should be aggressively promoted in dental settings.


The authors would like to thank the study participants for their participation and kind cooperation throughout the study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

 > References Top

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Global Youth Tabacco Survey Collaborative Group. Tobacco use among youth: A cross country comparison. Tob Control 2002;11:252-70.  Back to cited text no. 2
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Tomar SL, Winn DM, Swango PA, Giovino GA, Kleinman DV. Oral mucosal smokeless tobacco lesions among adolescents in the United States. J Dent Res 1997;76:1277-86.  Back to cited text no. 9
Tomar SL, Winn DM. Chewing tobacco use and dental caries among U.S. men. J Am Dent Assoc 1999;130:1601-10.  Back to cited text no. 10
Bowles WH, Wilkinson MR, Wagner MJ, Woody RD. Abrasive particles in tobacco products: A possible factor in dental attrition. J Am Dent Assoc 1995;126:327-31.  Back to cited text no. 11
Tyas SL, Pederson LL. Psychosocial factors related to adolescent smoking: A critical review of the literature. Tob Control 1998;7:409-20.  Back to cited text no. 12
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National Center for Chronic Disease Prevention and Health Promotion, Global Youth Tobacco Survey; Available on the Web Page of National Center for Chronic Disease Prevention and Health Promotion. Available from: http://www.cdc.gov/tobacco/global/gyst/GYTS_countryreports.htm. [Last cited on 2015 Jan 08].  Back to cited text no. 16
WHO. Tobacco in SEAR: A Health Challenge. New Delhi: WHO, SEAR; 2011.  Back to cited text no. 17
Qidwai W, Zahid N. Characteristics of smokers and their knowledge about smoking at a teaching hospital in Karachi. Pak J Med Sci 2005;21:109-11.  Back to cited text no. 18
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  [Figure 1], [Figure 2]

  [Table 1]


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