|Year : 2020 | Volume
| Issue : 2 | Page : 115-121
Prevalence of Tobacco Consumption among Men in Amarpur Village, Uttar Pradesh, India, May 2019: A cross-sectional study
Ali Jan Nazari, Naveen H Simon, Ajoke Akinola, Muskan Kaushik
Department of Public Health, School of Health Science, Noida International University, Uttar Pradesh, India
|Date of Submission||14-Jun-2019|
|Date of Decision||01-Sep-2019|
|Date of Acceptance||20-Sep-2019|
|Date of Web Publication||8-Oct-2020|
Department of Public Health, School of Health Sciences, Gautam Budh Nagar, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: Globally, there are over 7 million deaths resulting from tobacco consumption with 1 million deaths in India per year, and among middle-income countries listed as the second major consumer of tobacco products. The prevalence of tobacco consumption according to the recent studies already done is dissimilar among gender, different age categories, religion, urban and rural areas. The study purpose was to assess the prevalence of tobacco consumption among rural men. Methodology: Community-based cross-sectional study conducted from December 2018 to May 2019 in Amarpur village, Uttar Pradesh, India. There were 244 men in the age group of 15–54 years old, selected for the survey. Purposive sampling technique was used for taking sample and SPSS 16 software for statistics analysis. Results: The prevalence of smoked and smokeless tobacco was 36.1% and 42.6%. The most prevalent form of tobacco among smoked form was bidi and hookah, while among smokeless forms were gutka with paan. Among the smokers, 69.3% were willing to quit smoking on smokeless consumers and 78.8% were willing to stop tobacco consumption at some point. Age, marital status, education, and the number of children were associated with tobacco smoker and chewer. Tobacco was highest 38 (48%) among 25–34 years of age for tobacco smoker with P = 0.002, and tobacco chewer highest among 35–44 years which was 34 (61.8%) with P = 0.000. About one-third of the patients do not know that tobacco intake has ill effect on their health; the most common influencing factors for tobacco use were for enjoyment and stress. Conclusion: Prevalence of tobacco consumption was high in this community. Urgent awareness and increased literacy needed to improve knowledge on the effect of smoking in the rural area. Through the development of effective health education and multi-factorial quitting strategies to help those who are willing to quit tobacco.
Keywords: Cross-sectional study, education, health, prevalence, tobacco use
|How to cite this article:|
Nazari AJ, Simon NH, Akinola A, Kaushik M. Prevalence of Tobacco Consumption among Men in Amarpur Village, Uttar Pradesh, India, May 2019: A cross-sectional study. CHRISMED J Health Res 2020;7:115-21
|How to cite this URL:|
Nazari AJ, Simon NH, Akinola A, Kaushik M. Prevalence of Tobacco Consumption among Men in Amarpur Village, Uttar Pradesh, India, May 2019: A cross-sectional study. CHRISMED J Health Res [serial online] 2020 [cited 2020 Dec 1];7:115-21. Available from: https://www.cjhr.org/text.asp?2020/7/2/115/297583
| Introduction|| |
Tobacco consumption is one of the main risk factors for many chronic diseases such as oral cancer, lung diseases, cardiovascular disease, and many other diseases. Regarding tobacco consumption and its prevalence, and hence, many studies and surveys have been done in different time periods. Some of the latest studies were conducted during a decade ago till now; these studies have shown that tobacco uses are dissimilar among different countries, people, and gender.
Various studies not limited to the WHO reports 2012–2019, tobacco kills ≥7 million people each year globally, and one person dies within 6 s due to tobacco consumption in India; among middle-income countries were listed as the second major consumer of tobacco products. Around 267 million people are using any form of tobacco, and 1 million people die each year in India due to diseases caused by tobacco consumption.,
As per recent Global Adult Tobacco Survey (GATS) conducted during 2016–2017 in all over India they found that the prevalence of tobacco consumption was 28.6% in any form, and it was much dissimilar among gender, rural, and urban area. According to the National Report of GATS was conducted in 2017, they reported that 30 different types of smokeless tobacco are available in India along with a variety of smoked form. Due to different types and varieties of tobacco form and negative health impact, tobacco changed to a major public health issue in India. As per hospital-based cross-sectional study which was conducted in Dental College (Dharwad, Karnataka) India, in 2013. Oral mucosal lesions were found 28.6% among the participants those who had tobacco smoking and chewing tobacco habit. Only 2.8% found among those participants who did not have the habit.
Oral cancer cases account to around 30%–40% of all cancer cases in India, and the most common causes of oral cancer are tobacco consumption, either smoking or smokeless form. Especially in Uttar Pradesh and North India, oral cancer cases were high because of extraordinary rate of smokeless tobacco consumption. Concerning this India started tobacco control program legislation since 1975 along with various legislations. Thereafter, smoking in public places, bus, train, and advertisement of tobacco products is prohibited in all social media, and tobacco smoking has been banned in educational institutes, all health-care establishment, and air-conditioned buses.
Knowledge, awareness, and attitude regarding tobacco along with awareness of negative health effects of consuming tobacco products have had a direct relation with the prevalence of tobacco. The most challenges and problems, the government of India and tobacco control program in National, State, and district level faced, were insufficient knowledge, culture, religion influence, high illiteracy rate, and wrong believes. Due to these reasons still they cannot implement the proper implementation of the programs.
There is a need for a detailed assessment to find out the real burden and prevalence of tobacco, to take action as per needed. Because tobacco products are highly lethal for its consumer, so an urgent action is needed to save the lives.
| Methodology|| |
A cross-sectional study was conducted among men during December 2018–May 2019 in Amarpur village that was covered by Noida International University, Uttar Pradesh (UP), India, to assess the prevalence of tobacco consumption in any form, either smoked or smokeless form; however, the study population was all men in the age group of 15–54 years old. The sample size was calculated by the following formula.
Where, z is confidence level, e is the desired level of precision, p is the (estimated) proportion of the population which has the attribute in question, and N is population size. The main population was 644 men, the study was calculated in confidence interval 95%, margin of error or precision 5%, and P = 0.5. Purposive sampling technique is used for taking the sample because the study assessing the prevalence of tobacco consumption only among men. After applying this formula, the sample size came out 244 patients, and hence, this sample size was collected and included in this study [Figure 1].
The study included male in the age group 15–54 years old, all resident of the village, educated and uneducated, the study excluded female, men <15 years and >54 years old, and nonresident of the study area.
Data collected by the structured questionnaire that had four parts. The first part was demographic variables, the second part was questions related to smoking, the third part was questions related to smokeless, and the fourth parts were questions related to health status and tobacco awareness.
Ever consumer in this study are those patients who had used any form of tobacco in his or her lifetime, past user of tobacco who had used tobacco product in any time but not used within the past 30 days, current consumers of tobacco are those who have used tobacco products within the last 30 days.
The different types of tobacco products mentioned in this study were divided into types: smoked and smokeless forms, cigarettes, bidis, and hookah are the examples of smoked form of tobacco, gutka, and paan masala are the examples of smokeless forms of tobacco, and the smokeless forms of tobacco are not burned. It can be applied to teeth, chewed, or snuffed.
After collecting the data, it was analyzed using the SPSS version 16 (Statistical Package for the Social Sciences (SPSS), IBM Company), and descriptive statistic is used to calculate the frequency, percentage, and mean, and Chi-square test was applied for any significant relation between demographic variables with tobacco consumption. Informed consent was taken from all participants, and confidentiality was maintained, approval for the study was granted by the Research Committee Review Board of Noida International University, Gautam Budh Nagar, UP India.
| Results|| |
A total 244 responded participated in this study, of these, the prevalence of tobacco consumption was found 36.1% in smoked form, 42.6% was in smokeless form. It shows that the prevalence of smokeless form of tobacco was higher than the smoked form. Among the tobacco smokers, bidis and hookah were the most popular, the majority 73.8% were consuming. Gutka and paan masala were the most common form among smokeless tobacco consumer, 70.2% were consuming. The respondents divided into four age categories: 15–24, 25–34, 35–44, and 45–54 years old. Of these participants, 2 (0.8%) were uneducated, 44 (18.0%) were completed primary school, 83 (34.0%) were completed secondary school, and 115 (47.1%) were graduated and above. The majority of participants, 210 (86.1%) were Hindu, and 34 (13.9%) were Muslim.
In this study, 32 (13.1%) of the applicants were unmarried, 208 (85.2%) were married, 2 (0.8%) were divorced, and 2 (0.8%) were widower, and majority of respondents, 64.3% were self-employee, 20.1% were answered that they are temporary employee, and 17 (7.0%) responded that they are unemployed.
Among the smokers, 69.3% were willing to quit smoking on smokeless consumers, and 78.8% were willing to stop tobacco consumption at some point. Only 63.9% of the patients knew that tobacco intake has ill effect on their health, and the most common influencing factors for tobacco use were for enjoyment and stress.
Result of the study according to objectives
As per the first objective, to find out which form of tobacco is used more either smokeless (chewing) or smoked form.
[Figure 2] illustrates that out of 244 participants, 61% were consuming tobacco in any form, and 39% of the participants were not using tobacco products in any form.
[Table 1] shows the prevalence of tobacco consumption among all participants among all participants. Of 244 applicants, 88 (36.1%) were smoker, and 156 (63.9%) were nonsmoker.
Moreover, it also illustrates that the prevalence of smokeless tobacco among men was 104 (42.6%), and 140 (57.4%) were nonuser of smokeless tobacco. It shows that the prevalence of smokeless was higher than the prevalence of smoking.
[Figure 3] shows the percentage of smoker in different age categories, that indicates what age group has more smoker and what age group has the lowest smoker, according to this table, the age group of 35–44 years is the highest, 41.8% of the participants are smoker in this age category, and the age group of 15–24 years is the lowest, and 16.4% of applicants are smoker.
[Figure 4] shows the percentage of smokeless consumer in different age categories, to indicate what age group is more consume smokeless tobacco, and what age group are the lowest, according to this bar chart, the age group of 36–45 years is the highest, that the study shown that 61.8% of participants in these age group were the user of smokeless, and the age group of 15–25 years is the lowest, in this age group, 14.5% were smokeless user.
[Table 2] shows the reasons, why people are smoking?As per the study result, out of 244 participants, 88 people were smoker; out of 88 participants', 11 persons responded due to stress, 37 participants said for enjoyment, seven people answered because of addiction, two applicants answered because of friend influence, two people responded because of addiction with enjoyment, 21 participants answered they are using to reduce the stress along with enjoyment, two people responded because of friend influence along with enjoyment, and six participants responded due to both reduce the stress and because of addiction they are smoking.
[Figure 5] shows the percentage of associated factors which are leading to smokeless tobacco consumption. Among the smokeless tobacco consumer 45% of the participants responded they are using smokeless tobacco for enjoyment. 15% of participants answered because of stress, 7% responded due to addiction, 16% answered because of both enjoyment and addiction, 7% said for enjoyment and friend influence, 4.7% responded because of stress, addiction and enjoyment, and 4.7% answered to reduce the stress and enjoyment they are consuming smokeless tobacco [Table 3].
|Table 3: Characteristics association between demographic variables with smoking (n=88) and smokeless tobacco user (n=104)|
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The Chi-square test showed that there is a significance relation between smoking and age, marital status, and number of children. There is no significance relation between smoking and education level, religion, and occupation.
As per Chi-square test shows that there is a significance relation between smokeless tobacco uses and age group, education level, marital status, and number of children. There is no significance relation between smokeless tobacco consumption with religion and occupation, and hence, they are independent.
| Discussion|| |
The prevalence of tobacco consumption in this study was 36.1% in smoked form, and 42.6% was in smokeless form with 93.2% current tobacco user, which is higher than other studies conducted in some parts or in all over parts of the India. Verma et al. conducted a cross-sectional study regarding tobacco prevalence in Mandla district. They found the prevalence of tobacco 43.8%, which is almost similar to the result this study but when comprised with cross-sectional study conducted by Gupta et al. in Darbhanga district from September 2014 to February 2015, which was much lower than the finding of this study. A cross-sectional study was conducted between June 2007 and March 2008 among 2513 individuals in urban area of Jamnagar, India. They found the prevalence of tobacco in any form 37.2%, in this study, the most preferred form of chewing form was mawa masala 63.72% followed by gutka 57.6% were consuming. However, in this study, gutka was the most preferred form of chewing tobacco followed by paan.
The study was conducted by GATS, from 2016 to 2017 in all over India, they were found the prevalence of tobacco 28.6%. As compared to this study, the prevalence of tobacco consumption is much higher than the GATS survey. Prevalence of smokeless form of tobacco significantly was higher than the prevalence of smoked form, and a cross-sectional study was conducted in rural community Jaipur, Rajasthan (India) in 2015, they found smoked form of tobacco was higher than the smokeless form of tobacco. Smoking was highest in the age group of 46–60 years, although in the recent study, smoking was highest in the age group of 35–44 years.
Rane et al. conducted a descriptive cross-sectional study during January–June 2015 among 825 fishermen in Udupi Taluk, Karnataka, India. The study have shown that the consumption of tobacco in any form was 64.2%. Prevalence of tobacco was the highest in the age group of 39–48 years, and it was the lowest in the age group of 29–38 years old. Moreover, other cross-sectional study conducted in in two rural and mountainous districts of Uttrakhand, India. They found smoking form of tobacco was highest in the age group of 52–67, the result of these studies was dissimilar with the result of the recent study. Arora et al., conducted a study from October to December 2017 among auto rickshaw drivers in South Delhi. The reasons that they responded why they are using tobacco, include the following factors. 31% of the participants responded during waiting hours on the job, 24% said due to addiction, 16% answered to ward off sleepiness during driving, 13% said peer pressure, 14% responded physical stress, and 26% answered because of mental stress, they are using or consuming tobacco.
Patel et al. conducted other study among 372 undergraduate medical students from 1st to 4th year during November 2013–January 2015, the reasons why they consuming involved the following reasons, 60 participants responded the reason for tobacco consumption as due to peers influence, 13 applicants answered because of parent influence, 20 participants responded due to TV/movies influence, 84 persons answered because of relief stress, 8 participants responded due family problem, and 18 persons answered do not know.
In this study, the reasons why they are consuming are involved the following reasons. Among the smokers, about 37 (15.2%) responded consuming for enjoyment, and the lowest percentage 2 (0.8%) answered due to addiction and friend influence. Among the smokeless consumers, the reasons for consuming smokeless tobacco were 48 (19.7%) for enjoyment, 17 (7.0%) due to enjoyment with addiction, 16 (6.6%) due to stress, and the lowest percentage 5 (2%) due to this three factors (stress, enjoyment, and addiction).
| Conclusion|| |
Prevalence of tobacco consumption was high in this community, awareness and literacy rate regarding ill effect on health is not good along with false perception about tobacco. There is a need to develop effective health education and multifactorial quitting strategies to help those are willing to quit tobacco.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2], [Table 3]