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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 29  |  Issue : 3  |  Page : 205-208

An epidemiological study of tobacco-related oral habits in Mahabubnagar district of Telangana, India


1 Department of Oral Medicine and Radiology, Government Dental College, Vijayawada, Andhra Pradesh, India
2 Private Practice, Hyderabad, India
3 Department of Oral Medicine and Radiology, Sri Venkata Sai Institute of Dental Sciences, Mahaboobnagar, Telangana, India
4 Department of Oral Medicine and Radiology, Maharana Pratap Dental College, Kanpur, Uttar Pradesh, India
5 Private Practice, Vijayawada, Andhra Pradesh, India

Date of Submission26-Apr-2017
Date of Acceptance25-Jun-2017
Date of Web Publication20-Nov-2017

Correspondence Address:
Ramesh K Koothati
Department of Oral Medicine and Radiology, Government Dental College, Vijayawada, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_40_17

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   Abstract 

Aim: To assess the prevalence of tobacco-related oral habits (TROH) in Mahabubnagar district of Telangana, India. Materials and Methods: A cross-sectional study was conducted among 3200 participants in Mahabubnagar district of Telangana, India. People aged 16–75 years and both men and women in same proportions were included in the study. Data was obtained by interviewing individual participants regarding various TROH. Results: Out of 3200 participants, 750 (23.44%) had TROH, whereas 2450 (76.56%) did not have any tobacco habits. In 750 participants who had TROH, the habit of tobacco chewing was more common (44.5%) followed by the habit of smoking (42.7%) and both smoking and chewing (12.8%). Conclusion: From the present study, we can conclude that prevalence of TROH is alarmingly high in this district. Oral physicians have an important role in tobacco control as they can directly see the harmful effects of tobacco in the mouth.

Keywords: Chewing tobacco, smoking tobacco, tobacco-related oral habits


How to cite this article:
Koothati RK, Reddy GV, Ramlal G, Prasad LK, Kumar VJ, Pokala A. An epidemiological study of tobacco-related oral habits in Mahabubnagar district of Telangana, India. J Indian Acad Oral Med Radiol 2017;29:205-8

How to cite this URL:
Koothati RK, Reddy GV, Ramlal G, Prasad LK, Kumar VJ, Pokala A. An epidemiological study of tobacco-related oral habits in Mahabubnagar district of Telangana, India. J Indian Acad Oral Med Radiol [serial online] 2017 [cited 2020 Dec 3];29:205-8. Available from: https://www.jiaomr.in/text.asp?2017/29/3/205/218719


   Introduction Top


Tobacco is one of the legal consumer products that can harm everyone exposed to it. Although tobacco is the single most preventable cause of death in the world today,[1],[2],[3] its use is common throughout the world due to low prices and inconsistent public policies against its use.[1],[2] According to the World Health Organization (WHO), currently about 5 million people die prematurely every year in the world due to the use of tobacco.[3] By 2030, this death toll will exceed 8 million a year. Unless urgent action is taken, tobacco could kill 1 billion people in this century.[1],[2]

India is the second-largest consumer of tobacco in the world, there are about 250 million tobacco users in India who account for about 19% of the world's total 1.3 billion tobacco users.[4] The consumption of tobacco via smoking, chewing, snuffing, etc. is the leading cause of cancers in India.[5] An estimated 1 million Indians die annually from tobacco-caused diseases, and projections forecast that by 2020, tobacco will account for 13% of deaths in India.[6],[7] WHO predicts that India will have the fastest rate of rise in deaths attributable to tobacco use.[3] The tobacco epidemic in India is notable for the variety of smoked and smokeless products that are used and for their production by entities ranging from loosely organized manufacture of beedi and smokeless products to multinational corporations.[6] India's tobacco problem is more complex than that of any other country in the world, with a large consequential burden of tobacco-related disease and death.[3],[8]

The global literature is only of limited help in assessing the problem of tobacco use in India because the dominant and the most researched form of tobacco use globally is cigarette smoking. In India, cigarette smoking comprises a minor part of the overall tobacco problem. The major smoking problem in India is beedi smoking, and a large part of the overall tobacco problem is the oral use of smokeless tobacco products. All forms of tobacco use are inferred to be unsafe for human health. Mere extrapolation of the results of tobacco research in developed countries would, therefore, not provide a full picture of the tobacco problem in India. This requires that the Indian experience be carefully documented, hence, this study was attempted to assess the prevalence of tobacco-related oral habits (TROH) in Mahabubnagar district of Telangana, India because Mahabubnagar district is one of the backward districts of Telangana state with the highest rural population and the lowest literacy rate in the state.[9],[10],[11],[12],[13]


   Materials and Methods Top


A cross-sectional study was conducted to assess the prevalence of TROH in Mahabubnagar district of Telangana, India over a period of 6 months from January to June 2012. A pilot study was conducted before the start of the main study to know the feasibility and to calculate the sample size. The sample size was estimated to be 3,200 for the population of 40 lakhs by using the prevalence of TROH, which was 26% according to the pilot study. A “simple random cluster sampling method”[14] was used in this study and a total of 8 clusters were selected from the entire district by following the district map, which includes 4 rural clusters and 4 urban clusters.

A total of 3200 participants were included in the study from a total of 8 clusters (400 participants from each cluster including 200 males 200 females). People aged 16–75 years and both men and women in same proportions were included in the study. The study was done by conducting camps in Government Hospitals located in each cluster area. Ethical clearance was obtained from the Ethical Committee of Sri Venkata Sai Institute of Dental Sciences, Mahabubnagar and prior permission was taken from the Superintendents of the government hospitals. Participants were explained about the study and written consent was obtained from each participant. The participants were stratified according to age and gender, but not by occupation.

Data was obtained by interviewing individual participants regarding various TROH (either smoking tobacco or chewing tobacco or both the habits) if they indulged in any and entered into the proforma simultaneously. Habit of alcohol consumption has not been taken into consideration in this study. All the included participants were educated individually in their own language regarding the health consequences of tobacco abuse and tobacco users were motivated to quit the habit and to report early to an oral physician if they detect any suspicious lesions in their mouth. Obtained data was entered into Microsoft Office Excel spreadsheet 2007 and was subjected to analysis using IBM SPSS Statistics for Windows, Version 20.0, Armonk, NY, IBM Corp. release 2012. Categorical variables were compared for proportions among the groups using Chi-square test. A P value of <0.05 was considered statistically significant. The results are presented as numbers and percentages.


   Results Top


Out of 3200 participants, 750 (23.44%) had TROH whereas 2450 (76.56%) did not have any tobacco habits. Hence, the prevalence of TROH in Mahabubnagar district of Telangana was 23.44% [Table 1]. In 750 participants who had TROH, the habit of tobacco chewing was more common (44.5%) followed by the habit of smoking (42.7%) and both smoking and chewing (12.8%). From all the 4 rural clusters, 140 (43.8%) participants had a smoking habit, 179 (53.6%) had a chewing habit, and 53 (55.2%) had both smoking and chewing habits, whereas in 4 urban clusters, 180 (56.3%) participants had a smoking habit, 155 (46.4%) had a chewing habit, and 43 (44.8%) had both smoking and chewing habits. There was a significant difference between rural and urban participants in terms of tobacco usage where usage of tobacco was high in urban subjects (P = 0.021) [Table 2].
Table 1: Distribution of different tobacco related oral habits among the study participants

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Table 2: Distribution of different forms of tobacco-related oral habits

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Among female participants, 27 (8.4%) had a smoking habit, 169 (50.6%) had a chewing habit, and 0 (0%) had both smoking and chewing habits, whereas among male participants, 293 (91.6%) had a smoking habit, 165 (49.4%) had a chewing habit, and 96 (100.0%) had both smoking and chewing habits. There was a highly significant difference between female and male participants in terms of tobacco usage where usage of tobacco was high in males (P< 0.001) [Table 2].

Among young adult participants (16–35 years), 99 (30.9%) had a smoking habit, 124 (37.1%) had a chewing habit, and 46 (47.9%) had both smoking and chewing habits, whereas among middle-aged participants (36–55 years), 136 (42.5%) had a smoking habit, 184 (55.1%) had a chewing habit, and 50 (52.1%) had both smoking and chewing habits. Among old-aged participants (56–75 years), 85 (26.6%) had a smoking habit, 26 (7.8%) had a chewing habit, and none had both smoking and chewing habits. Analysis of variance test was used to compare different age groups. A P value of <0.001 was obtained which was statistically significant [Table 2].

Among the different varieties of TROH, the habit of chewing noncommercial variety tobacco product (23.47%) was more common followed by the habit of smoking cigarettes (22.13%), the habit of chewing commercial variety tobacco product (21.07%), the habit of smoking beedi (11.33%), and the habit of smoking chutta (9.2%) [Table 3].
Table 3: Different types of tobacco-related oral habits among different forms of tobacco-related oral habits

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   Discussion Top


In India, tobacco is used in a wide variety of ways: smoking, chewing, applying, sucking, gargling, etc. For each type of tobacco use, a wide range of tobacco products are available. Some of the products are industrially manufactured on a large scale, some locally on a small scale, some may be prepared by a vendor, and some may be prepared by the users themselves. Tobacco use is harmful to health in many ways. In India, where tobacco is smoked, chewed, and applied in a wide variety of ways, a considerable number of studies have shown that these forms of tobacco use are causal risk factors for many types of cancers and other diseases.[3],[15],[16]

The present study was conducted to assess the frequency of TROH such as smoking and chewing of tobacco among males and females, different age groups, and rural and urban population in Mahabubnagar district of Telangana, along with the prevalence of different varieties of smoking and chewing forms of tobacco among the participants. In the present study, in both rural and urban areas, the presence of TROH was more in males (73.8%) than that in females (26.2%), probably because of sociocultural factors; these results were similar to the study conducted by Chaudhry et al. in 2001 in three districts of Karnataka. Among participants 10 years of age and above, 49.2% males, and 16.4% females in the rural areas were tobacco users whereas in urban areas, 32.7% males and 8.5% females were tobacco users.[17]

In the present study, the habit of smoking (52.9%) was more common in males followed by the habit of chewing (29.7%) and the habit of both smoking and chewing (17.4%). In females, the habit of chewing (86.3%) was more common followed by the habit of smoking (13.7%) and no female had the habit of both smoking and chewing (0%). These results were similar to the study reported by Sen in 2002 which was conducted among 12,000 individuals aged 18 years and above in urban Kolkata where smoking among men was 38% and chewing was 36% and women users were nearly exclusively chewers (19%).[18] Another study conducted by Mohan et al. in 2002 reported similar results; 27.7% males and 2.7% females were smokers.[19] In the present study, 0.8% of females had the habit of smoking and 5.3% of females had the habit of chewing. These results are similar to the study conducted by Rani et al. in 2003 where 2.4% of women smoked and 12% chewed tobacco.[20]

Report of Global Adult Tobacco Survey (GATS), India (2009–2010) revealed the state of the epidemic of tobacco use in India which was comprehensively described in the recently completed GATS, an internationally standardized survey designed to track tobacco use around the world. The findings document the unique characteristics of tobacco use in India, highlighting the challenge for tobacco control. The GATS data show that India faces diverse epidemics of tobacco use involving cigarettes, beedis, and various forms of smokeless tobacco. The epidemics differ by sex, with men more often smokers and women more often users of smokeless tobacco, by population subgroup and by state. Over 35% of adults in India use tobacco, primarily smokeless (about 164 million), but there are 69 million users who only smoke, and an additional 42 million users of both smokeless and smoked products. The majority of adults are exposed to secondhand smoke.[21] In the present study, the habit of tobacco chewing was more common (44.5%) followed by the habit of smoking (42.7%) and the habit of both smoking and chewing (12.8%). These results were similar to the report of GATS, India (2009–2010).


   Conclusion Top


From the present study, we conclude that prevalence of TROH are alarmingly high in this district. However, there is a need for further studies with a larger sample and more detailed parameters to assess the exact proportion of people having different TROH in Mahabubnagar district of Telangana, India. Government should make policies towards tobacco control, and nongovernment organizations and civil societies should take part in it. Health professionals especially oral physicians and general dentists should also take part in advancing the agenda of tobacco control in the community. Dentists have an important role in tobacco control as they can directly see the harmful effects of tobacco in the mouth. They should contribute to the principal agency through which information on the health consequences of tobacco is communicated to people as well as policy-makers. They also provide direct services for tobacco cessation, through counseling and other forms of therapy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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