Tobacco consumption and its association with education among women residing in a rural area of Maharashtra: A cross-sectional study

Factors Influencing the Consumption of Tobacco amongst the Khasi Indigenous People in Northeast India

Background

Tobacco use in any form is a major public health concern. It accounts for nearly 1.35 million deaths every year. Many chronic illnesses occur due to the consumption of tobacco, either smoke or smokeless form. The study aims to explore how smoking and smokeless tobacco consumption are distributed across a range of demographic and socioeconomic markers among Khasi indigenous people in Northeast India.

Materials and Methods

It is a case-control study conducted in adults over 31 years of age. The study was carried out between June 2020 and August 2021. An Independent t-test was performed to determine the significant difference in age between smoking/smokeless tobacco users and non-tobacco users. Univariate and Multivariate analyses were conducted to determine the significant predictors affecting the use of smoking/smokeless tobacco in the respondents.

Results

A total of 505 respondents were included in the present study. There was a high statistically significant difference in the income level of tobacco and non-tobacco users (P value- 0.002). In Univariate analysis, it was found that the odds of consuming both forms of tobacco were significantly lower in the respondents aged between 51-60 (OR = 0.61, P value = 0.0453). The participants who studied till graduation and above had lower odds of both using forms of tobacco as compared to respondents who were illiterate/primary educated only (OR = 0.85, P value = 0.046).

Conclusion

In conclusion, smoking and smokeless tobacco consumption are still widely prevalent in this region and strongly associated with age, gender, level of education, and place of residence. There is a need for further detailed analysis to identify risk factors that are strongly associated with the use of smoke and smokeless tobacco so that the community will be conscious about the hazardous effects of tobacco use in any form.

Systematic review and meta-analysis of the prevalence of smokeless tobacco consumption among adults in Bangladesh, India and Myanmar

OBJECTIVE

To estimate the pooled prevalence of smokeless tobacco consumption (STC) by gender and location in Bangladesh, India and Myanmar and to identify periodic changes in STC prevalence using data extracted from published studies.

METHODS

We searched for a combination of keywords in electronic databases and used a standard form to extract data from each article. We undertook a meta-analysis to estimate pooled prevalence and confidence intervals within these countries. To compare periodic changes in STC prevalence, we grouped studies into five-year periods (2000-2004, 2005-2009, 2010-2014 and 2015-2019).

RESULTS

The pooled estimates of STC prevalence were 25% (95% CI: 22-28%), 22% (95% CI: 15-28%) and 21% (95% CI: 14-28%) for Bangladesh, India and Myanmar, respectively. In pooled estimates across these countries, we found higher STC prevalence for men (30%; 95% CI: 24-35%) than women (16%; 95% CI: 10-23%) and for rural dwellings (24%; 95% CI: 18-31%) than urban dwellings (17%; 95% CI: 10-24%). We found significant decrease in STC in Bangladesh and India in the period 2010-2014 and 2015-2019, respectively. In Myanmar, STC prevalence increased significantly and substantially in 2010-2014, to levels higher than in Bangladesh and India.

CONCLUSIONS

The prevalence of STC in Bangladesh, India and Myanmar is highest in rural areas and among men. Public health prevention strategies are needed to maintain decrease in STC in Bangladesh and India, and to reverse the increased use in Myanmar.

Education differential in relation to tobacco use and its predictors across different regions of India

BACKGROUND

Tobacco use and education of an individual are linked to each other. Educated people are more likely to practice healthy behaviors and are aware of the harms of tobacco use. This paper uses the Global Adult Tobacco Survey data (GATS-India) to study the education differential associated with tobacco use and its predictors across India.

METHODOLOGY

Secondary data analysis was conducted for GATS conducted in 2009-2010 in India. Data for "illiterate" and "literate" study subjects were analyzed according to study subject's "tobacco consumption pattern," their "quitting behavior," "exposure to second hand smoke (SHS)" and "observing health warnings on tobacco products."

RESULTS

Tobacco smokers and smokeless tobacco users were more likely to be illiterate (odds ratio [OR] for smoking tobacco = 1.2; for smokeless tobacco = 1.5) as compared to their counterparts. Significantly, more illiterate initiated smoking tobacco (OR = 1.1; 1.02-1.26) and smokeless tobacco habit (OR = 1.3; 1.21-1.44) before 17 years of age. Illiterate people were less likely to try quitting tobacco (smoking tobacco = OR = 0.8; 0.79-0.94; smokeless tobacco = OR = 0.7; 0.70-0.81) and also less likely to think of quitting tobacco in near future (smoking tobacco = OR = 0.6; 0.59-0.71; smokeless tobacco = OR = 0.6; 0.57-0.66). Illiterate people were more likely to be exposed to SHS at home (OR = 1.8; 1.7-1.9) and less likely to notice health warnings on cigarette packets (OR = 0.2; 0.26-0.28) and smokeless tobacco pouches (unadjusted OR = 0.5; 0.49-0.53).

CONCLUSION

The results confirm that education differential exists for tobacco use and its determinants in India. It is recommended that all people of our country should have access to quality education. Policy makers should target uneducated people so as to reverse the tobacco epidemic.

Effectiveness of a structured teaching program (STP) on cessation of tobacco chewing, on knowledge and attitude among female hospital housekeeping personnel - a pilot study

AIM

To evaluate the effectiveness of a structured teaching program (STP) on: a) improving knowledge of female hospital housekeeping personnel regarding harmful impact of tobacco chewing and how to quit, and b) fostering an unfavorable attitude toward tobacco chewing.

METHODS

The STP focused on adverse health effects of tobacco chewing, myths and facts, and tobacco cessation. It was administered in regional language to female hospital housekeeping personnel (N=35) over three days. Post-assessments were conducted at 4 weeks following the last session of the STP.

RESULTS

Current tobacco use was reported by 26% of the sample. Tobacco chewers (vs. non-chewers) were more likely to be significantly older, have elementary education, belong to nuclear family, have lesser knowledge regarding harmful effects, and have a more favorable attitude toward the practice of tobacco chewing. At the end of 4 weeks following the STP, participants significantly improved their knowledge regarding the harmful health impact of tobacco chewing and how to quit (p=0.001), and showed a significantly less favorable attitude toward tobacco chewing (p=0.001). Change in participants' knowledge scores was found to be negatively correlated with change in attitude scores, implying that increase in knowledge was associated with less favorable attitude toward tobacco chewing (r=-0.427, p=0.011).

CONCLUSION

Findings provide preliminary evidence for the effectiveness of health education on harmful impact of tobacco chewing and how to quit, delivered through a STP, in improving knowledge and fostering an unfavorable attitude toward tobacco chewing, among female hospital housekeeping personnel.

Association between Shammah Use and Oral Leukoplakia-like Lesions among Adult Males in Dawan Valley, Yemen

BACKGROUND

Shammah is a traditional form of snuff dipping tobacco (a smokeless tobacco form) that is commonly used in Yemen. Oral mucosal changes due to the use of shammah can usually be observed in the mucosal surfaces that the product touches. The aim of this study was to determine the association between shammah use and oral leukoplakia-like lesions. Other associated factors were also determined.

MATERIALS AND METHODS

A cross sectional study was conducted on 346 randomly selected adult males. Multi-stage random sampling was used to select the study location. After completing the structured questionnaire interviews, all the participants underwent clinical exanimation for screening of oral leukoplakia-like lesions Clinical features of oral leukoplakia-like lesion were characterized based on the grades of Axell et al (1976). Univariable logistic regression and multivariable logistic regression were used to assess the potential associated factors.

RESULTS

Out of 346 male participants aged 18 years and older, 68 (19.7%) reported being current shammah users. The multivariable analysis revealed that age, non-formal or primary level of education, former shammah user, current shammah user, and frequency of shammah use per day were statistically associated with the presence of oral leukoplakia-like lesions [Adjusted odds ratio (AOR) = 1.03; 95% confidence interval (CI) : 1.01, 1.06; P= 0.006], (AOR= 8.65; 95% CI: 2.81, 26.57; P= 0.001), (AOR= 3.65; 95% CI: 1.40, 9.50; P= 0.008), (AOR= 12.99; 95% CI: 6.34, 26.59; P= 0.001), and (AOR= 1.17; 95% CI: 1.02, 1.36; P= 0.026), respectively.

CONCLUSIONS

The results revealed oral leukoplakia-like lesions to be significantly associated with shammah use. Therefore, it is important to develop comprehensive shammah prevention programs in Yemen.

Tobacco-related knowledge, attitudes, and practices among urban low socioeconomic women in Mumbai, India

CONTEXT

Tobacco use is an important health issue globally. It is responsible for a large number of diseases and deaths in India. Female tobacco users have additional health risks.

AIMS

The aim was to assess changes in pre and post-intervention tobacco-related knowledge, attitudes, and practices among women from urban low socioeconomic strata, after three rounds of interventions.

SUBJECTS AND METHODS

A structured questionnaire was used to interview women living in low socioeconomic housing clusters in Mumbai, regarding their tobacco consumption, attitudes, and practices, by Medical Social Workers. These data were entered into IBM SPSS Statistics, version 20 and analysed. Interventions for tobacco cessation were provided 3 times over a span of 9 months, comprising of health education and counseling. Post-intervention questionnaire was introduced at 12 months.

RESULTS

There was statistically significant improvement in the knowledge of women, following the interventions, with particular reference to poor oral hygiene and tobacco use being main cause of oral cancer (P = 0.007), knowledge of ill effects of second hand smoke (P = 0.0001), knowledge about possibility of early detection of oral cancer (P = 0.0001), perception of pictorial and written warnings on tobacco products (P = 0.0001), and availability of help for quitting tobacco (P = 0.024).

CONCLUSION

The prevalence of smokeless tobacco use is very high among urban women from lower socioeconomic strata. Therefore, tobacco awareness programs and tobacco cessation services tailor made for this group of women must be planned and implemented.