Sociodemographic factors associate with tobacco use among rural population of Maharashtra

Bahattare V N¹, Lohakpure V R^2*

¹Assistant Professor, ²Epidemiologst-cum-Assistnt Professor, Department of Community Medicine, Swami Ramanand Teerth Government Medical College, Ambajogai, Maharashtra, INDIA.

Email: dranujingole@gmail.com

Abstract               Background: Tobacco use is the single greatest cause of preventable death globally. Tobacco use is a major public health challenge in India with 275 million adults consuming different tobacco products. India is also the second largest consumer of tobacco in the world, second only to China. An environmental tobacco smoke, or second hand smoke, has been shown to cause adverse health effects in people of all ages. Hence the present study was conducted mainly to find out Sociodemographic factor associated with tobacco use. Objective: To study socio-demographic factors associated with tobacco use. Materials and Methods: A cross-sectional study was conducted during 2016 in a field practice area of   medical college. The study included 400 family All the adult population between age group 10 to 75 year were interviewed as per predesigned, pre-tested and semi-structured questionnaire in local language. Total 3252 rural population interviewed for tobacco use. Results: Overall prevalence of tobacco use found in this study was 63.16%.All socio-demographic factors which we taken under study influence tobacco use that was statistically significant. Conclusions: Though various legislation ban use of tobacco still tobacco use were significantly higher as found in our study. So effective measure should be directed and policy measure should be implemented effectively in order to decrease overall use.

Key Words: tobacco, rural population.

INTRODUCTION

Tobacco use is the single greatest cause of preventable death globally. As many as half of people who use tobacco die from the results of this use. The World Health Organization (WHO) estimates that each year tobacco causes about 6 million deaths (about 10% of all deaths) with 600,000 of these occurring in non smokers due to second hand smoke.^1,2,3

Tobacco use is leading risk factor for NCDs (Non communicable disease) and SDG (Sustainable development goal) 3.a addresses the implementation of the WHO Framework  Convention on Tobacco Control with tobacco use selected as an indicator of progress .In 2015 over 1.1 billion people used tobacco.⁴ Tobacco consumption is responsible for 50% of all the cancers in men and 25% in women.⁵ Tobacco use is a major public health challenge in India with 275 million adults consuming different tobacco products. India is also the second largest consumer of tobacco in the world, second only to China.  The prevalence of tobacco use among adults (15 years and above) is 35%. The prevalence of overall tobacco use among males is 48 percent and that among females is 20 percent. Nearly two in five (38%) adults in rural areas and one in four (25%) adults in urban areas use tobacco in some form.⁶ The chewing of betel quid (a mixture of the leaf of the Piper betle vine, aqueous calcium hydroxide paste [slaked lime], pieces of areca nut [supari], and frequently some spices) was a popular habit that had already been integrated into social and cultural life in India. After its introduction, tobacco soon became a new ingredient in betel quid (pan), which has become the most commonly used form of smokeless tobacco. Habitual betel quid chewing is commonly practised by men and women, while tobacco smoking is much more common among men in these countries compared to women.⁷ In India, tobacco is consumed in several forms, which include smoking as well as smokeless tobacco. While “bidis,” which are small, thin hand-rolled cigarettes comprising of tobacco wrapped in tendu leaves, are predominantly smoked in rural India, other available varieties are hookah, chuttas, cigarettes, and cigars. Tobacco is also chewed extensively in India; use of chewable tobacco is in the form of paan masala, gutka, and other locally prepared mixtures of tobacco, areca nut, and additives. Paan is made from piper betel leaf filled with sliced areca nut, lime, catechu, and other spices chewed with or without tobacco. Chewing of paan with tobacco is a popular habit that has been integrated into customs and traditions in rural India.⁵ The National health policy 2017 of Govt of India has set the target of “Relative reduction in prevalence of current tobacco use by 15% by 2020 and 30% by 2025”⁸ An environmental tobacco smoke, or second hand smoke, has been shown to cause adverse health effects in people of all ages. Hence the present study was conducted mainly to find out Sociodemographic factor associated with tobacco use.
MATERIALS AND METHODS

A community based cross-sectional study was carried out during Jan-April 2016 in a Rural Community Health Center (CHC), which comes under a field practice area of  Tertiary medical college. The study included 400 family. Sample size for study calculated by taking prevalence of tobacco use in rural area as 40% with 90% statistical power and 5% level of significance using formula it came out 384.⁹ All the rural population between age group 10 to 75 year were interviewed as per predesigned, pre-tested and semi-structured questionnaire in local language by house-to-house visits by health staff after getting informed consent. Ethical clearance/approval to the study was obtained from Institutional Ethical committee. The data so collected were compiled, tabulated, analyzed and interpreted using Microsoft Excel 2007 and analyzed by Epi info. Percentages and proportions were calculated and Chi square test was applied as test of significance.

The primary outcome in the present analyses was tobacco use, categorized as follows Smokers who also used smokeless tobacco were classified as smokers in these analyses. The response variable, tobacco use, was converted into a dichotomous variable in which current tobacco users (including users of any form of tobacco) were compared with current nonusers. The socio-demographic factors which influence Tobacco use like age, sex, religion, marital status, education, present occupation, family income. For calculating socio-economic status (SES), modified BG Prasad’s classification was used.¹⁰

RESULTS                        

A total of 3252 persons were interviewed and examined during the study period which revealed that majority (82.41%) belonged to 20-49 year age group with Most of them were Hindus (87.08%) and males (82.10%). 2.83% were below poverty line and larger bulk belong to lower middle (55.66%) class. 68.97% belonged to Joint families and maximum proportion were residing in Kacchha house (83.03%). Overall prevalence of tobacco use found in this study was 63.16%.

Table 2 shows tobacco consumption by age, sex, religion, marital status, literacy level, present occupation, social class, type of family and place of residence. Significantly more males (90.90%) than females (9.10%) consumed tobacco in various forms. Most of study population consumed tobacco were between 20-49 year age group, this differential pattern was Statistically significant across age categories (𝜒2= 293.3; <0.05). Individuals who were employed (92.70%) were more likely to use tobacco than individuals who were unemployed (3.70%)  the association between tobacco consumption and occupation was statistically significant (𝜒2= 161.6; 𝑝 < 0.05). Likewise, tobacco consumption pattern increased with literacy level upto secondary class while it is found low in higher secondary and above (15.87%) The association between tobacco use and educational categories was found to be statistically significant (𝜒2= 312.6; < 0.05). Most of the Tobacco user were lower middle social class (53.84%), Joint family (88.90%) and were residing in kacchha house (85.64%).

All this association was found to be statistically significant. The present study provides information on various factors associated with Tobacco use in rural area. Most common reason behind initiation of tobacco were pleasure (80%) followed by peer pressure (15%) and Advertisement (3%) [Figure 1]

Table 1: Sociodemographic factors associated with tobacco use

Figure 1: Reason for Initiation of Any form of Tobacco use

DISCUSSION

The finding of present study mainly related to rural area overall prevalence of Tobacco use was 63.16% while most of tobacco users were male (90.90%) and this finding similar to other studies perform other part of country in similar setting.^5,11 The present results demonstrate that age determining factor in tobacco consumption which was similar to other study. In tobacco use patterns associate with sociodemographic variable was similarly mentioned in studies done at various places.^11,12,13 The observed that more tobacco use associated with increase in prevalence of tobacco consumption with age. Previous literature suggests no declining trends in tobacco consumption over time in India.^14,15 Observed increase in tobacco prevalence in present may be due to tobacco products such as bidis, gutka, and paan masala are locally manufactured, inexpensive, and easily available in rural India. Crude forms of tobacco are easily available and accessible, are relatively cheaper, and are used by socioeconomically disadvantaged people.    

CONCLUSION

Even after kwon fact that Tobacco use and exposure are associated with a wide range of debilitating diseases including various types of cancers tobacco use highly prevalent and most of factor social correlate are highly significant. Though various legislation ban use of tobacco still tobacco use were significantly higher as found in our study. So effective measure should be directed and policy measure should be implemented effectively in order to decrease overall use.

Acknowledgement: We thank my entire colleague and all departmental staff for their support and co-operation.

REFERENCES

1. World Health Organization (2008). WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package (PDF). Geneva: World Health Organization. p. 8. ISBN 92-4-159628-7.
2. "Tobacco Fact sheet N°339". May 2014. Retrieved 13 May 2015
3. Wikipedia contributors. Health effects of tobacco. Wikipedia, The Free Encyclopedia. August 5, 2016, 03:53 UTC. Available at: https://en.wikipedia.org/w/index.php?title=Health_effects_of_tobacco&oldid=793988828. Accessed August 8, 2016
4. K.Park Textbook of Preventive and social medicine 24th Ed.pg 511.
5. Payal Kahar, Ranjita Misra, and Thakor G. Patel, “Sociodemographic Correlates of Tobacco Consumption in Rural Gujarat, India,” BioMed Research International, vol. 2016, Article ID 5856740, 9 pages, 2016. doi:10.1155/2016/5856740
6. Kaur J, Jain D C. Tobacco Control Policies in India: Implementation and Challenges. Indian J Public Health 2011;55:220-7
7. Gupta PC, Ray CS. Smokeless tobacco and health in India and South Asia. Respirology.   2003 Dec;8(4):419-31.Review.PMID:14708551
8. B. Gupta, “Burden of smoked and smokeless tobacco consumption in India—results from the global adult tobacco survey India (GATS-India)—2009-2010,” Asian Pacific Journal of Cancer Prevention, vol. 14, no. 5, pp. 3323–3329, 2013.
9. Lwanga S.K. LS. Sample Size - Lwanga_Lameshow.pdf. Genewa, World Health Organization; 1991.
10. Parashar S.S.L. Principles of sociology and health care. In Social Behavioral and Communication sciences. [Internet] 4; 113: 611.(cited on 1.4. 2009) Available in http://www.whoindia.org /Link Files /Human_Resources_Section4-Textbook_on_Public_ Health_ and Community_ Medicine.pdf
11. Majumdar R, Raje SS, Dandekar A. Sociodemographic factors associated with tobacco use in rural Maharashtra. Med J DY Patil Univ 2013; 6:161-4.
12. K. R. Thankappan and C. U. Thresia, “Tobacco use and social status in Kerala,” Indian Journal of Medical Research, vol. 126,no. 4, pp. 300–308, 2007.
13. M. Rani, S. Bonu, P. Jha, S. N. Nguyen, and L. Jamjoum, “Tobacco use in India: prevalence and predictors of smoking and chewing in a national cross sectional household survey,”Tobacco Control, vol. 12, no. 4, 2003.
14. K. R. Thankappan & C. U. Thresia Tobacco use & social status in Kerala Indian J Med Res 126, October 2007, pp 300-308
15. M Rani, S Bonu, P Jha, S N Nguyen, L Jamjoum Tobacco use in India: prevalence and predictors of smoking and chewing in a national cross sectional household survey Tobacco Control 2003;12:e4 (http://www.tobaccocontrol.com/cgi/content/full/12/4/e4