Pattern of use, Contributing Factors and associated oral health problems among chewing Tobacco users in Urban Slum of Odisha
Shyama Devi1, Azhar S M2, Ravneet Pannu3, Anisha Manna3, Devika M S3, Subhrajyoti Barik3, Kirti3
1Assistant Professor, College of Nursing, AIIMS, Bhubaneswar.
2Tutor, College of Nursing, AIIMS, Bhubaneswar.
3BSc (Hons) Nursing Student, College of Nursing, AIIMS, Bhubaneswar.
*Corresponding Author Email: azhar86sm@gmail.com
ABSTRACT:
Background: The overall smokeless tobacco users in India is 29.6% as per Global Adult Tobacco Survey (GATS 2). Chewing tobacco causes dependence and various health risk among the users. The purpose of this study was to assess the pattern, contributing factors and associated oral health problems related to chewing tobacco use among adults. Methods: A cross-sectional study was conducted among 130 adults residing in a selected urban area of Odisha. A convenient sampling technique was adopted and the data was collected using structured questionnaire, Fagerstrom Nicotine Dependence Scale for smokeless tobacco (FTND-ST) and observational checklist. The data was analysed using descriptive and inferential statistics. Results: The mean age among chewing tobacco users was 41.01+10.75 with majority being males (82.3%) using chewing tobacco. The participants with no formal education (32.3%) and those who are self employed (59.2%) have a considerable percentage of using chewing tobacco. 56.2% of participants were mild to moderately dependent on chewing tobacco whereas 43.8% of the adults were severely dependent. About 36% of participants were influenced by peer group for using chewing tobacco. The associated oral health issues among users include bad breath (50%), tooth discoloration (90.8%), dental caries (53.1%), build-up of plaque and tartar over teeth (77.7%) and adverse effect on gum (37.7%) which includes pain on gums, swelling and redness. About 7% of users took their last dip of chewing tobacco within 5 minutes before going to bed. There is significant association among participants who consume chewing tobacco on daily basis with oral health problems like plaque and tartar on teeth, blackish gum discoloration and spontaneous gum bleeding. Conclusion: The present study signifies the need of lifestyle hygiene and the importance of self- motivation and medical attention for quitting chewing tobacco.
KEYWORDS: Chewing tobacco, Pattern, Contributing factors, Oral health problems.
INTRODUCTION:
Substance abuse is an issue that we are frequently coming across and has engulfed the human society and has resulted in significant social damage.
The path from initiation to harmful use of substances among young people is influenced by factors at personal level (including behavioural and mental health, gene variation resulting from social influences), the micro level (parental and family functioning, schools and peer influences) and the macro level (socioeconomic and physical environment)1. The tobacco epidemic is one of the biggest public health threats the world has ever faced.2
Smokeless tobacco (ST) refers to various tobacco-containing products that are taken by chewing, sniffing or keeping in the mouth, rather than smoking.3 Chewing tobacco is a form of smokeless tobacco (ST), the juice of which causes sores and white patches in the mouth which can lead to cancer of mouth, pharynx, oesophagus, pancreas and stomach. Oral tobacco contains at least 28 carcinogenic chemicals, where tobacco specific nitrosamines are most harmful among them. Other than cancer its use also has an increased risk of heart attack and stroke. The studies shown that those who switch from cigarette smoking to chewing tobacco were more than 2.5 times as likely to develop cancer of mouth and throat compared to those who quit smoking altogether4.The Global Adult Tobacco Survey conducted among those aged 15 years or above revealed that smokeless tobacco use was most common form of tobacco use and is strongly associated with various oral lesions including precancerous lesion and has an addictive property5
Nicotine, one of the main contents of tobacco is most potent CNS stimulant and has high abuse potential.6 With nicotine a wide range of toxic metals including lead, mercury etc. are also used in tobacco products which causes respiratory depression, cardiac-arrhythmia, GI disturbances, carcinogenicity and psychomotor agitation.7
The financial constraints and economic burden to tackle mortality and morbidity related to tobacco can take a major hate on low middle-income country like India where the public spending on health is merely 1.2% of gross domestic product.1 Thus the present study aimed to determine the pattern of use, contributing factors and associated oral health problems related to chewing tobacco among adults in selected urban area.
METHODOLOGY:
A cross-sectional study was conducted among chewing tobacco users in Urban slum, Odisha. Using non-probability convenient sampling 130 participants who were using chewing tobacco between age 19-59 years were enrolled. The study was approved by institutional ethical committee and an informed consent was taken from each participant before conducting the study. A semi-structured questionnaire containing 27 items was used to assess the various contributing factors such as socio-demographic variables, availability of tobacco products, knowledge regarding health issues related to chewing tobacco and influence of peer group. Modified Fagerstrom Nicotine Dependence Scale for smokeless tobacco (FTND-ST) was used to assess the pattern of tobacco use. An oral health checklist was included to rule out the associated oral health problems related to chewing tobacco use. Content validity of the tool was done by experts.
The data was collected and entered in Microsoft excel. Descriptive analysis was done to understand the contributing factors, pattern of tobacco use and associated oral health problems among smokeless tobacco users. Chi-square test was used to find out the association among the variables i.e. pattern of tobacco use with associated oral health problems and selected contributing factors; selected contributing factors with associated oral health problems.
RESULTS:
Table 1: Contributing factors for chewing tobacco use. N-130
|
Sl. No. |
Contributing factors of chewing tobacco use |
Frequency |
Percentage |
|
1. |
Socio-demographic variables: |
|
|
|
1.a |
Age in years(mean+SD) 19-29 30-39 40-49 50-59 |
(41.01+10.75) 23 34 36 37 |
17.7 26.2 27.7 28.4 |
|
1.b |
Gender Male Female |
107 23 |
82.3 17.7 |
|
1.c |
Education No schooling Primary school High school Higher secondary and above |
42 38 29 21 |
32.3 29.2 22.3 16.2 |
|
1.d |
Occupation No occupation Self-Occupation Government and private employees |
26 77 27 |
20 59.2 20.8 |
|
1.e |
Socioeconomic status PPH (priority household) NPH( Non-priority household) |
82 48 |
63.1 36.9 |
|
2. |
Availability of chewing tobacco products |
|
|
|
2.a |
Usual carry of chewing tobacco product Yes No |
80 50 |
61.5 38.5 |
|
2.b |
Area of buying chewing tobacco products Workplace Home Wherever possible |
67 33 30 |
51.5 25.4 23.1 |
|
3. |
Knowledge regarding health issues related to chewing tobacco Yes No |
105 25 |
80.8 19.2 |
|
4. |
Influence of peer group for using chewing tobacco Yes No |
83 47 |
63.8 36.2 |
The mean age of participants were 41.01+10.75 with majority being males (82.3%) using chewing tobacco. The participants with no formal education (32.3%) and those who are self-employed (59.2%) have a considerable percentage of using chewing tobacco. 61.5% of the participants used to carry tobacco products with them and their most common area for buying was found to be near workplace.
Figure 1: Pattern of chewing tobacco use among adults
Figure 2: Age of initiation of chewing tobacco use.
Majority of adult (80.8%) were having knowledge regarding adverse effect of chewing tobacco on health. The result of the study also shows that 63.8% of participants were influenced by peer group for using chewing tobacco. (Table 1)
Among chewing tobacco users, 56.2% were mild to moderate dependent on chewing tobacco whereas 43.8% of the adults were severely dependent on chewing tobacco. (Figure 1)
About 55% of subjects initiated chewing tobacco during adolescent age group where 28.5% of subjects initiated between 20-29 years of age. (Figure 2)
The present study shows that among various influencing factors for initiation of chewing tobacco use among adults, the highest was peer group influence 47(36.2%). Majority of the users (74.6%) chew tobacco on daily basis. Approximately 60% of participants take tobacco at any spot. Study also reveals that approximately 17% participants take last dip of tobacco 31-60 minutes before going to bed, whereas 7% participants takes the last dip within 5 minutes before going to bed. (Table 2)
About 45% of the chewing tobacco users have someone in their family using chewing tobacco. 49.2% of participants consume chewing tobacco with their friends whereas 13.8% of participants consume chewing tobacco with their family members. 51.5% of the participants have tried quitting chewing tobacco. 26.2% of the participants use more than 50 rupees per day for the purchase of chewing tobacco products. Also it was found that the dental carries was higher among age group 50-59 years among those who chew tobacco.
Table 2: Other patterns of chewing tobacco use
|
S. No |
Type of use |
Frequency |
Percentage |
|
1. |
Influencing factors for initiation of chewing tobacco use Peer group Easy availability Low cost Stress Family gatherings Others |
47 35 33 30 11 14 |
36.2 26.9 25.4 23.1 8.5 10.8 |
|
2. |
Frequency of intake of chewing tobacco Daily Weekly Monthly |
97 29 4 |
74.6 22.3 3.1 |
|
3. |
Area of intake of chewing tobacco. Any spot Workplace and home |
77 53 |
59.2 40.8 |
|
4. |
Time of last dip before going to bed 60minutes 31-60minutes 6-30minutes Within 5minutes |
62 23 36 9 |
47.7 17.7 27.7 6.9 |
Figure 3: Associated oral health problems among adults using chewing tobacco.
Table 3: Association of pattern of chewing tobacco use with associated oral health problems. N-130
|
S. No. |
Oral health problems |
Pattern of chewing tobacco use |
Chi square |
df |
P value |
|
|
|
|
Mild to moderate dependence |
Severe dependence |
|
|
|
|
1. |
Adverse effects on gum Yes No |
23 50 |
19 38 |
0.049 |
1 |
0.048 |
Bar graph (Figure 3) shows associated oral health problems among adults using chewing tobacco. Out of 130 study participants, 65(50%) presented with bad breath, 118(90.8%) subjects had tooth discoloration, 69(53.1%) of the participants presented with dental caries and 101(77.7%) participants had build-up of plaque and tartar over teeth. Adverse effect on gum includes pain on gums (21), swelling (15) and redness on gums (13).
There is significant association of pattern of chewing tobacco use with adverse effect on gum (χ2=0.049, p= 0.048) at 0.05 level of significance. (Table 3)
There exist a significant association of dental caries with age of the participants (χ2=21.47, p=0.000), the habit of usual carry of chewing tobacco with build-up of plaque and tartar on teeth (χ2=8.79, p=0.003) and blackish discoloration of gum (χ2=5.2, p=0.017) among the participants, knowledge about health problems related to chewing tobacco with dental caries (χ2=3.62 and p= 0.046) and adverse effects on gum (χ2=5.83 ,p= 0.011), peer group influence with blackish discoloration of gum (χ2=3.59, p=0.043) and adverse effect of gum (χ2=4.09 , p=0.032), frequency of tobacco use with black discoloration of gum (χ2 = 0.013, p=0.010), gum bleeding (χ2 = 0.06, p = 0.047) and build up of plaque and tartar (χ2 = 0.001,p= 0.00) at 0.05 level of significance.
DISCUSSION:
In this cross-sectional study we examined the pattern of use, contributing factors and associated oral health problems among chewing tobacco users in a selected urban slum. The data was collected from 130 chewing tobacco users. About 18% of chewing tobacco users was in the age group between 19 - 29 years. More than half of the participants were having either no formal education or primary education and majority of them were employed. These findings are in line with the other study.8
Nearly half of the participants were severely dependant on chewing tobacco which is higher than reported by other studies9. More than half of participants initiated their chewing tobacco use during the adolescent age group which is in accordance with other studies.10
We observed that nearly 64% of participants who were using chewing tobacco belong to priority household which is in line with other studies.11,12 One forth of the participants spent more than 50 rupees per day for the purchase of chewing tobacco products.
Peer group influence was major influencing factor for chewing tobacco use among 36.2% participants in the present study where about half of the participants used to consume tobacco with their friends. Similar findings have been supported by other studies.13
According to Global Adult Tobacco Survey-2 ( GATS 2) data, 94% adult users believed that use of smokeless tobacco causes serious illness.14 The present study result also showed that most of the adults (80.8%) had knowledge that chewing tobacco is injurious to health. This result is consistent with the other studies.15,16
Associated oral health problems were observed among chewing tobacco users which includes bad breath (50%), tooth discoloration (90.8%), buildup of plaque and tartar over teeth (77.7%), dental carries (53.1%), blackish discoloration of gum (36.2%) and adverse effects on gum (32.3%). The present study findings were concordant with another study which exhibits higher rates of gingival bleeding, periodontal pockets and loss of attachments among chewers17. Another study shows higher prevalence of periodontal disease among nicotine dependent individuals18.
Adults who had access to tobacco products at workplace and home were found with more oral health problems. Here the presence of dental carries was higher among age group 50-59 whereas other study reported higher prevalence of mucosal lesion among 46-60 years old males.19 The subjects belonged to priority household has been noted with increased associated oral health problems than non-priority household which is in line with other studies.20
There is significant association among participants who consume chewing tobacco on daily basis with oral health problems like plaque and tartar on teeth, blackish gum discoloration and spontaneous gum bleeding which is in accordance with other study.21 The participants with duration of more than 25 years of using of chewing tobacco have significant association with dental caries.
More than half (51.5%) of the chewing tobacco users have tried quitting its use in our study which is in accordance with GATS 2 where 49.6% of current smokeless tobacco users were planning or thinking of quitting smokeless tobacco use.14
The study was done on small sample of chewing tobacco users and in a single setting which limits the generalization of the findings. Also the study provides us the point estimation of the problem as the design is cross sectional. We recommend further long term studies to be carried out on a larger population.
CONCLUSION:
The availability of chewing tobacco is increasing day by day which make the people more dependent on it. Most of the people started using chewing tobacco at the adolescent period and peer group influence plays a major influencing factor for initiation where the dependency potential of nicotine make chewing tobacco more dependent. Tobacco use needs to be regulated through proper education and enforcement activities.
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Received on 15.02.2022 Modified on 18.06.2022
Accepted on 14.09.2022 ©AandV Publications All right reserved
Asian J. Nursing Education and Research. 2023; 13(1):5-9.
DOI: 10.52711/2349-2996.2023.00002