|Year : 2019 | Volume
| Issue : 4 | Page : 318-322
Knowledge, attitude and practice towards areca nut use among medical student of Nagpur city
Apeksha S Dhole1, Shreya Chandrashekhar Kohale2, Mukta Motwani3, Adeeba Siddique2
1 Prof. PG Guide, Department of Oral Medicine and Radiology, VSPM, DC and RC, Nagpur, Maharashtra, India
2 PG Student, Department of Oral Medicine and Radiology, VSPM, DC and RC, Nagpur, Maharashtra, India
3 Prof. and Head, Department of Oral Medicine and Radiology, VSPM, DC and RC, Nagpur, Maharashtra, India
|Date of Submission||09-Oct-2019|
|Date of Acceptance||06-Jan-2020|
|Date of Web Publication||03-Mar-2020|
Dr. Apeksha S Dhole
Professor, Department of Oral Medicine and Radiology, VSPMDC and RC Digdoh Hills, Hingna Road, Nagpur- 440 019, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Areca nut is consumed by approximately 600 million people worldwide and is the fourth most common psychoactive substance used globally and also gaining popularity among younger populations. There is substantial evidence that areca nut is the sole factor for the causation of premalignant condition like oral submucous fibrosis, aggravating asthma, liver fibrosis, hypertension, etc., and has its deleterious effects on other system of the body as well. As the MBBS curriculum does not include the awareness regarding the detrimental effects of areca nut use, it becomes mandatory for people from health science fraternity including medical students to have knowledge and awareness regarding such harmful agents. Therefore, the study is planned to assess the knowledge, attitude and practice toward areca nut consumption among medical students. Aim: To assess the knowledge, attitude, and practice toward areca nut consumption among medical students of Nagpur city. Methodology: After getting approval from the Institutional Ethics Committee dated 22nd July2019, this cross-sectional study was carried out at VSPM DC and RC in collaboration with NKP SIMS Nagpur. The validated questionnaire was designed which comprised of 23 close-ended questions to asses about knowledge, attitude, and practice toward consumption of areca nut. The questionnaire was prepared on Google form which was then sent via e-mail among 200 medical students including interns and post-graduates willing to participate in the study and their responses were obtained by five-point Likert scale that ranges from strongly agree to strongly disagree. Results: There was a high percentage of unawareness regarding knowledge and attitude parameters and lack of practice of areca nut among medical students. Conclusion: There is need “to update” the knowledge and awareness among medical students regarding hazards of the areca nut use by conducting CME programs in order to provide better life quality to the patients.
Keywords: Areca nut, fibrosis, medical students, precancerous condition
|How to cite this article:|
Dhole AS, Kohale SC, Motwani M, Siddique A. Knowledge, attitude and practice towards areca nut use among medical student of Nagpur city. J Indian Acad Oral Med Radiol 2019;31:318-22
|How to cite this URL:|
Dhole AS, Kohale SC, Motwani M, Siddique A. Knowledge, attitude and practice towards areca nut use among medical student of Nagpur city. J Indian Acad Oral Med Radiol [serial online] 2019 [cited 2020 Jun 4];31:318-22. Available from: http://www.jiaomr.in/text.asp?2019/31/4/318/279859
| Introduction|| |
Arecanut is the fourth most common addiction found globally following tobacco, alcohol and caffeine. It is popularly known as betel nut or Supari. Areca nut chewing habit is common in Central, Southern and South-east Asian countries, including Bangladesh, China, India, Pakistan, Philippines, Sri Lanka, Taiwan, and Vietnam. Areca nut chewing is not only limited to Asia but is also consumed by immigrant communities settled in Australia, Europe, and the USA. It has been estimated that globally 600 million individuals (approximately 10%–20% of the world population) chew areca nut regularly. India is the largest producer of areca nut and at the same time the largest consumer also. Major states cultivating this crop are Karnataka (40%), Kerala (25%), Assam (20%), Tamil nadu, Meghalaya, and West Bengal which is consumed in the form of betel quid, gutkha with or without tobacco, and as an ingredient in small sachets of supari chewable products, which are industrially produced and also gaining popularity among younger populations. Arecaidine, a hydrolyzed derivative of arecoline, has been reported to stimulate the central nervous system, thereby giving a sensation of alertness, well-being, and dizziness, depending on the amount and frequency of areca nut consumption.
Use of areca nut among adults is a serious problem in developing countries. As areca nut is a socially accepted product and also available at home, adolescence and young individuals are more prone to these habits. They are more easily attracted toward marketing strategy than the adults and if their friends or relatives chewed areca nut, they are more eager to try this kind of habit.
Oral submucous fibrosis (OSF) is a chronic, insidious condition that occurs predominantly among Indians and occasionally in other Asians especially Taiwanese and sporadically in Europeans. The hallmark of the disease is submucosal fibrosis that affects the oral cavity and progressively involves the pharynx and the upper esophagus.
There is substantial evidence for the carcinogenicity of areca nut in cancers of the mouth and esophagus. Apart from this, areca nut also has widerange of effects on the other systems of the body including heart, lungs, brain, GIT, and reproductive organs. It aggravates preexisting conditions such as neuronal injury, myocardial infarction, cardiac arrhythmias, asthma, central obesity, type II diabetes, metabolic syndrome etc., It affects the immune system leading to suppression of T-cell activity and decreased release of cytokines. It also has harmful effects on the fetus when used during pregnancy.
Oral cancer remains a major health problem and efforts for early detection and prevention will reduce this burden.
General Physicians are the first to approach by the patients, so they should be aware about the hazards of areca nut consumption. The MBBS curriculum does not include the information regarding the detrimental effects of areca nut. Hence, it becomes mandatory for people from health science fraternity including medical students to have knowledge and awareness regarding such harmful agents. There is only study which has assessed knowledge, attitude, and practice toward tobacco and areca nut use among medical students of Patna and found lack of knowledge and attitude among them. Therefore, the present study was undertaken to assess the knowledge, attitude, and practice toward areca nut use among medical students of Nagpur city.
| Materials and Methods|| |
After getting approval from the Institutional Ethics Committee on dated 22nd July 2019, this cross-sectional study was carried out at VSPM DC and RC in collaboration with NKP SIMS Nagpur. The validated questionnaire was designed, which comprised of 23 closed-ended questions. It was further divided into three sections to know about “knowledge, attitude, and practice” toward consumption of areca nut. The questionnaire was prepared on Google form which was then sent via e-mail among 200 medical students including interns and post-graduates willing to participate in the study and the responses were obtained by five-point Likert scale that ranges from strongly agree to strongly disagree.
In the knowledge section, data was collected whether students were aware about areca nut effects on oral cavity and on the other systems of the body as well.
In the attitude section, students' views about areca nut use were collected.
Regarding practices, questions whether students have habit of areca nut consumption were asked and if they responded yes to it, details of the habit were asked.
Descriptive data was analyzed in terms of frequencies and percentages and a score analysis was done by using SPSS software Ver. 20.0.
| Results|| |
Out of total sample population regarding knowledge, 57.5% strongly agreed and 42.5% agreed to consume a small quantity of areca nut is dangerous to health. 98.5% agreed and 1.5% disagreed that chewing areca nut can cause mouth and throat cancer. 39% agreed, 59.5% disagreed, and 1.5% were not aware about consumption of areca nut has immediate adverse effects in the oral cavity. 36% agreed, 61% were not aware of, and 3% disagreed that areca nut chewing has adverse systemic effects. 23% agreed, 75.5% were not aware of, and 1.5% disagreed that areca nut chewing has effect on offspring during pregnancy [Table 1] and [Graph 1].
|Table 1: Descriptive Statistics of knowledge towardareca nut use among medical students|
Click here to view
Out of the total sample population, students' view about areca nut consumption was 13% agreed, 58% were not aware of, and 29% disagreed that chewing areca nut relieves the stress. 32.5% agreed, 66% were not aware of, and 1.5% disagreed that chewing areca nut helps in appetite control.
Among all 25% agreed, 52% were not aware of and 23% disagreed that chewing areca nut increases working capacity. 25% agreed, 46% were not aware of, and 29% disagreed that chewing areca nut stimulates the salivation and helps in digestion. 43% agreed, 16% were not aware of, and 41% disagreed that chewing areca nut can be used as a mouth freshener. 46% agreed, 9.5% were not aware of, and 44.5% disagreed that advertisement plays an important role in increasing the consumption of areca nut. 43.5% agreed, 34.5% were not aware of, and 22% disagreed that people who use areca nut products have more friends [Table 2] and [Graph 2].
|Table 2: Descriptive statistics of attitude toward areca nut among medical students|
Click here to view
This was the heartening thing that we have found only one person have ever chewedareca nut in the form of mouth freshener and one had habit of chewing areca nut amongall. Source was from family member. Feeling on having arecanut was reported to be of being relaxed. Discomfort was the feeling reported on withdrawal of areca nut. Time since consuming in single subject was 1–6 months. Frequency of consuming was occasional and never suffered from any complications. And when asked about dentist visitation regarding the same, he/she never visited dentist due to complications regarding areca nut consumption [Table 3] and [Graph 3].
|Table 3: Descriptive Statistics of practice toward areca nut use among medical students|
Click here to view
| Discussion|| |
Health professionals, including future doctors, have a leading role in combating areca nut use in the community. They are the only one voice among many which can shape public health policy and have a unique position of respect and trust in society, which they can use to push people toward wellness. Thus, it is of great importance to determine their views and attitude toward this problem.
The anti-areca nut advice cannot come from a physician who is unaware about its deleterious effects on the whole body. Thus, we took medical students as the focus of our survey, as the approach and credibility of future physicians as treatment providers for areca nut-related diseases may be influenced by their knowledge.
Our “Anti-areca nut Acts” are mostly limited to papers and not being strictly enforced due to various reasons. People have a minimum concern about their necessity, implications, and violate laws at random. Legislative actions and health-propagandas like posters, banners, leaflets, etc., can change areca nut behavior of people very little, as very few of them actually know the evils of areca nut in depth. Moreover, social acceptance of its use, late and slow appearance of areca nut-related health hazards, mostly in chronic form, make people sometimes fail to correlate areca nut with morbidities caused by it and they remain less impressed by these statutory health warnings/danger symbols.,
Although this habit is equally distributed among all population groups, a generally higher proportion of school-going children are observed of consuming areca nut on daily basis in one or the other form., In India, the use of smokeless tobacco isbecoming more popular during the last few decades. The use of it seems to follow a rising trend, particularly among the street children and college students, which is a matter of serious concern. According to various studies, prevalence of chewing and smoking is increasing day by day and becoming a fashion among young individuals. Gupta et al. (2014) reported that out of 196 subjects of 15–18 years, 150 boys (76.5%) practice the habit of smoking 1–5 times a day and 46 (23.4%) practice the habit of chewing areca nut and gutkha 1–5 times a day. Out of 31 girls, 25 girls (80.6%) practice the habit of smoking 1–5 times a day and 6 (19.4%) practice the habit of chewing areca nut and gutkha 1–5 times a day. The sources of information about the areca nut/tobacco smoking were observing in the community, prompting by friends, and family influence. Goyal and Bhagwati also reported that 57% boys and 80.6% girls buy these products from their fellow colleagues while rest others buy these products from the nearby shops.
Regarding the knowledge and awareness of harmful effects of chewing habits, Singh et al. showed that 2842 (99.2%) school-going boys and 934 (99.5%) school-going girls were aware that tobacco use is harmful and similar proportions disliked it. Various studies have been carried out assessing the practice of a smoked and smokeless form of tobacco use among medical students. In 2008 Kumari and Nath carried out study on the use of tobacco among male medicals in Lucknow, India. And found that among the tobacco users (28.8%), smoking was found in 87.5%, and tobacco chewing in the form of gutkha, khaini, gulmanjan (locally available forms of tobacco) in 37.5% as the predominant means of the use of tobacco. In 1979, a study among 416 students of the Patna Medical College and Hospital showed that 41.3% were smoker and 1.9% chewed tobacco. Among smokers, 66.3% were light smokers, 25.6% moderate, and 8.1% heavy smokers. Patkar AA et al.in 2003 found that significantly fewer medical students (3.3%) smoked compared to nursind students (13.5%). Also, significantly more nursing students were former smokers (17.8%) than medical students (9.8%). The severity of nicotine dependence, as indicated by the total FTND score as well as scores on five of the six items on the FTND, was significantly lower among medical students compared to nursing students. Mandil A in 2005 reported smoking prevalence among 1057 sampled students was 15.1%, cigarette smokers were 9.4% and water pipe smokers 5.6%. While women comprised only 8.9% of cigarette smokers, they were 26.2% of water pipe smokers.
While going through the literature, only one study has been conducted which assessed practice of areca nut and tobacco among male medical students of Patna and found that among 400 male medical students who had responded to the survey, 172 (43%) were regular tobacco users and 3 (0.7%) were areca nut users. In addition, 110 (27.5%) were occasional tobacco users and 37 (9.2%) were occasional areca nut users.
While in the present study out of the total sample population, only one subject had the habit of areca nut chewing in the form of mouth freshener. According to Sinha et al., awareness regarding the specific ill-effects of different tobacco and areca nut products among the first, second, and third year students was less than 13%. This increased to 67% in the fourth year. This may be because the curriculum in these years hardly mentions tobacco- and areca nut-related disorders. There is some mention of these in the fourth year and, therefore, satisfactory answers were given by a larger number of fourth-year students. Hence, we took interns and postgraduates as the focus of our survey to know about their knowledge, views, and practice about areca nut consumption as they have been went through the curriculum.
Many studies have been conducted in this context and found awareness regarding tobacco consumption is there among the medical students but unfortunately not about areca nut use.
Nagpur being centrally located is the hub of areca nut trading and also considered as country's largest market for areca nut. Therefore, contemplating the above-mentioned points, the present study was conducted to assess the “knowledge, attitude, and practice” toward areca nut use among medical students at Nagpur City, which concluded that out of total sample population, 61% were not aware of that areca nut chewing has adverse systemic effects, 75.5% were not aware of areca nut chewing has effect on offspring during pregnancy, 58%thought that chewing areca nut relieves the stress, and 61% had belief that areca nut chewing helps in appetite control. This high percentage of unawareness is alarming as medical students are supposed to be knowledgeable about the ill effects of areca nut use.
| Conclusion|| |
The present study concluded that there was a lack of Knowledge and Attitude toward areca nut use among medical students of Nagpur City.
There is a need “to update”the knowledge and awareness among medical students regarding hazards of the areca nut use by conducting CME programs in order to provide better life quality to the patients.
Specific interventions that will help in preventing areca nut use not only among medical students but even earlier at high school and college are urgently required. Such interventions will have an impact on the future health care system. So that, we hope in the coming days all doctors will be real anti-areca nut leadersand will help in curbing the public health menace by setting examples in front of community and guide people for quitting areca nut.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sheth MS, Khan A, Rangey PB. Prevalence of areca nut and tobacco use in school-going children in Ahmedabad. Appl Med Res 2019;6:16-21.
Auluck A, Hislop GW, Poh CF, Zhang L, Rosin MP. Areca nut and betel quid chewing among South Asian immigrants to Western countries and its implications for oral cancer screening. Rural Remote Health 2009;9:1118.
Javed F, Chotai M, Tappvuni A, Khalid A. Systemic conditions associated with areca nut usage: A literature review. Scand J Public Health 2010;38:838-44.
Goyal G, Bhagawati BT. Knowledge, attitude and practice of chewing gutkha, areca nut, snuff and tobacco smoking among the young population in the Northern India population. Asian Pac J Cancer Prev 2016;17:4813-18.
Thakor N, Prajapati D. Tobacco and areca nut use among children of primary and secondary boarding schools of Gandhinagar district: A cross sectional study. Int J Adv Med 2014;1:137-40.
Khandelwal V, Nayak UA, Nayal PA, Khandelwal S. Sweetened areca nut chewing habit: Apublic health issue among school children of Indore, India. South East Asia J Public Health 2012;2:73-6.
Sinha DN, Gupta PC. Tobacco and areca nut use in male medical students of Patna. Natl Med J India 2001;14:175-9.
Roy M, Chakraborty AK. Smoking and drug abuse among the newly admitted students of medical colleges in West Bengal. Indian Public Health 1981;25:30-5.
Wali A, Siddiqui TM, Ejaj A, ShahabA. Knowledge, attitude and practice of areca nut, gutka and tobacco smoking amongst school children in Karachi. J Dent Sci 2016;4:39-43.
Kapoor SK, Anand K, Kumar G. Prevalence of tobacco use among school and college going adolscents of Haryana. Indian J Pediatry 1995;62:461-66.
Gupta D, Nagar P, Karim B. Tobacco use amongst the school going students of 15 to 18 years of Almora district, Uttarakhand: a cross sectional study. Oral Health Dent Manag 2014;13:680-6.
Singh V, Gupta R. Prevalance of tobacco use and awareness of risks among school children in Jaipur. J Assoc Physicians India 2006;54:609-12.
Kumari R, Nath B. Study on the use of Tobaccco among male medical students in Lucknow, India. Ind J Commun Med 2008;33:100-3.
Patkar AA, Hill K, Batra V et al
. Acomparison of smoking habits among medical and nursing students. A J redesign for Chest 2003;124:1415-20.
Mandil A, Hussein A, Omer H. Characteristics and risk factors of tobacco consumption among University of Sharjah students, 2005. East Mediter Health J 2005;13:1449-58.
[Table 1], [Table 2], [Table 3]