Journal of Pharmacy And Bioallied Sciences
Journal of Pharmacy And Bioallied Sciences Login  | Users Online: 3707  Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size 
    Home | About us | Editorial board | Search | Ahead of print | Current Issue | Past Issues | Instructions | Online submission




 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 6  |  Page : 1613-1619  

A cross-sectional study to assess factors that determine tobacco habit initialization and cessation and oral cancer awareness among general population of Vikarabad District, Telangana


1 Department of Public Health Dentistry, Malla Reddy Institute of Dental Sciences, Hyderabad, Telangana, India
2 Department of OMFS and Diagnostic Sciences, Faculty of Oral Pathology, Riyadh Elm University, Riyadh, Saudi Arabia
3 Department of Orthodontics and Dentofacial Orthopedics, Meghana Institute of Dental Sciences, Nizamabad, Telangana, India
4 Department of Public Health Dentistry, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
5 Department of Oral Pathology, Malla Reddy Institute of Dental Scieces, Jeedimetla, Hyderabad, Telangana, India

Date of Submission02-Apr-2021
Date of Acceptance09-May-2021
Date of Web Publication10-Nov-2021

Correspondence Address:
Ganesh Kulkarni
Department of Oral Pathology, Malla Reddy Institute of Dental Scieces, Jeedimetla, Hyderabad, Telangana
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.jpbs_312_21

Rights and Permissions
   Abstract 


Aims: The aim of the study was to assess factors that determine tobacco habit initialization and cessation and oral cancer awareness among the general population of Vikarabad district, Telangana. Materials and Methods: The current study was a cross-sectional study conducted among the general population of the Vikarabad district. All tobacco users satisfying inclusion criteria of age 18–40 years and at least 1 year of tobacco usage were included in the study. Multistage random sampling was followed to select tobacco users and structured, pretested questionnaires were distributed. The populations mean age was 30 years with majority being rural residents and men contributing the majority of the study population. Results: The mean age at which a person begins to smoke was 20.4 ± 5.7 years among the general population. Peer influence (77%) was reported as one of the major reasons, and habit formation was found to be the major factor (55.6%) for continuing tobacco and also work stress (17%) and relaxation (17%). The primary reason for quitting was fear or awareness of the adverse effects of tobacco. Self-abstinence was reported as a predominant method that they followed to quit tobacco habit during the past year, while 16.3% reported that they did not give it a try. About 58.6% of participants were advised by a health-care provider to quit tobacco, respectively. A major proportion of tobacco users (71%) knew that tobacco causes oral cancer. Half of the study population is unaware of oral cancer's early symptoms, noncontagious progression, lifestyle modification, and early treatment have a good prognosis. Conclusion: Findings of the study highlight the factors to be considered in framing effective antitobacco policies applicable to the rural population.

Keywords: Cessation, habit, oral cancer, tobacco, tobacco users


How to cite this article:
Gone H, Abdul NS, Pisarla M, Kumar KP, Kulkarni G, Audurthi RK. A cross-sectional study to assess factors that determine tobacco habit initialization and cessation and oral cancer awareness among general population of Vikarabad District, Telangana. J Pharm Bioall Sci 2021;13, Suppl S2:1613-9

How to cite this URL:
Gone H, Abdul NS, Pisarla M, Kumar KP, Kulkarni G, Audurthi RK. A cross-sectional study to assess factors that determine tobacco habit initialization and cessation and oral cancer awareness among general population of Vikarabad District, Telangana. J Pharm Bioall Sci [serial online] 2021 [cited 2022 Aug 8];13, Suppl S2:1613-9. Available from: https://www.jpbsonline.org/text.asp?2021/13/6/1613/330087




   Introduction Top


Modern civilization, industrialization, urbanization, changes in day-to-day life, population growth, and aging all have contributed to epidemiological changes in many diseases, including cancer, in India and other countries. In India, noncommunicable diseases were the leading cause of death in 2012, with an estimated burden of more than 1 million people diagnosed with cancer per year.[1] The National Programme for the Prevention of Cancer, Diabetes, Cardiovascular Disease, and Stroke, which has incorporated the earlier National Cancer Control Programme since2010, has made cancer a priority.[2]

Tobacco is classified as a category 1 carcinogen and is the leading cause of cancer, accompanied by alcohol intake, poor eating habits, insufficient physical activity, viral infections, and sexual activities.[3],[4] Tobacco has historically been considered a corrupting addiction, and addiction signs occur after a certain period of time, which can be comparable to a time bomb explosion.[5]

Tobacco users are a high-risk group for noncommunicable diseases; generally, this offers an opportunity to address multiple noncommunicable diseases in the same setting. Primary prevention, in the form of education and therapy about smoking and alcohol abstinence services, is a crucial and potential prevention method for these high-risk groups.

All types of tobacco use were found to be highly affected by age, education, and geographic location. Tobacco use is affected by a lack of awareness about particular tobacco risks.[6]

Each individual who refuses to heed tobacco warnings is driven by a complex web of motivation and addiction. Knowing the multiple factors influencing tobacco habit helps in formulating effective tobacco cessation curricula which influence health-care students' future clinical practice behavior.[7],[8] Tobacco being the prime factor in the development of oral cancer apart from habit-related information exploring awareness among tobacco users regarding oral cancer will be of no use. Literature about the awareness regarding oral cancer in the Indian population is very less.[9]

Keeping in mind the above reasons and need, our study was directed to measure the factors influencing tobacco habit characteristics, which is the root cause of high tobacco intake. This study aimed to assess factors that determine tobacco habit initialization and cessation and oral cancer awareness among the general population of Vikarabad district, Telangana.


   Materials and Methods Top


Study design

A cross-sectional epidemiological survey was conducted to assess factors that determine tobacco habit initialization and cessation and oral cancer awareness among the general population of Vikarabad district, Telangana. The district is spread over an area of 3386.00 km2. As per the 2011 census, the population was 3,927,140, and population density was 274 persons/km2.

Source of data and study population

The study population comprised ever tobacco users[10] among the general population of Vikarabad district, Telangana. Ever tobacco users refer to subjects who in their life have ever used tobacco of any kind. Inclusion criteria: (1) subjects aged 18–40 years, (2) individuals who disclosed their tobacco habit; (3) subjects having a history of tobacco consumption for a period of at least 12 months in a lifetime and the unwilling, mentally challenged, and subjects previously diagnosed with oral cancer were excluded.

Sample size determination and sampling procedure

A pilot study was performed on fifty tobacco users were randomly selected from two villages to assess the feasibility of the survey and to notice any difficulties encountered during data collection through questionnaire, as well as to ensure the questionnaire's level of validity and reliability (Cronbach's = 0.89), and the data from the pilot study were not included in the main survey. The sample size for the study was obtained from the formula:

nh = (Z2) (r) (1 − r) (f) (k)/(p) (n) (e2)

Statistic for 95% confidence interval (CI), Z = 1.96, expected proportion of important initiating or cessation factor, r = 0.10, design effect, f = 2, nonresponse, k = 1.1, total population for whom the parameter is applicable, P = 0.75, family size, n = 5, relative error, e = 0.15, sample size = (1.96) 2 (0.1) (0.9) (2) (1.1)/(0.75) (5) (0.015) 2 = 780 which was rounded up to 800.

A multistage random sampling technique was used. Using the lottery system, four mandals were randomly chosen from each revenue division, and four villages were chosen from each mandal. Thirty-two villages were chosen, with a total sample of 800 subjects spread evenly around the 32 villages, i.e. 25 subjects per village.

Before the study began, the Institutional Review Board of Sri Sai College of Dental Surgery, Vikarabad granted ethical approval (ref no. 557/2/COMD/SSCDS/IRB-E/2015). Following their guidance, relevant recommendations were integrated into the current study. Before the study, all participants gave their informed consent.

Data collection

Scheduling

Data collection was systematically scheduled to spread over 4 months, i.e. from May 2017 to August 2017. In spite of having a scheduled plan, few adjustments and changes had to be made while working it out practically.

Questionnaire

A self-designed structured questionnaire with questions customized to fulfill study objectives was used as a study instrument. The questionnaire included self-composed questions and questions adapted from previous literature, modified, and adapted contextually. The questionnaire was prepared including the sociodemographic details, tobacco habit characteristics, and oral cancer awareness.

The questionnaire constructed was then sent to an expert committee for checking its content and face validity. Later necessary corrections and modifications were done and were made ready to use in the research.

Participants were assured of anonymity as no information which reveals the identity of the participant was recorded in the questionnaire. Participation was not forced. Questionnaires were distributed to literates, whereas questions were read out loud for illiterates and literate subjects who requested for the same to record their answers. Forms with missing details were excluded from the analysis.

Statistical analysis

The data collected were compiled and double checked for accuracy. The analysis was carried out with the aid of the Statistical Package for the Social Sciences (SPSS 20.0 Version, Armonk, New York, USA). To record means and standard deviations for continuous variables and frequency distribution for categorical variables, quantitative descriptive analysis was performed using univariate statistics. The frequency of categorical variables was compared using Chi-square analysis. If P = 0.05 with a 95% confidence interval, the likelihood of occurrence by chance is significant. Microsoft Word was used to construct the tables and graphs.


   Results Top


The demographic features of the sample population are shown in [Table 1]. The mean age of the study population was 32.18 ± 6.42 years. The majority of them, i.e. 97.2% were males and were farmers, i.e. 53.8%. There was an approximately equal number of literates and illiterates.
Table 1: Distribution of study population based on their demographic variables

Click here to view


The percentage distribution of the study population based on tobacco habit characteristics is shown in [Table 2]. The majority of study participants, i.e. 60.1% were consuming tobacco daily.
Table 2: Distribution of study population based on tobacco habit characteristics

Click here to view


Among them, 64.0% and 32.1% were still consuming smoke form and smokeless form of the tobacco product, respectively. The rest 3.9% consumed or were still consuming both forms of tobacco product. Seventy-one percent of the study population had a family member who consumed tobacco.

[Table 3] shows the percentage distribution of the study population depending on the factors that led to the development of a tobacco habit. Around 41% said they started smoking for the first time when they were between the ages of 19 and 25. The mean age of initiation was found to be 20.4 ± 5.7 years among current study participants.
Table 3: Distribution of study population based on tobacco habit initiation factor

Click here to view


Around 73.8% of the study participants decided that their friends were the ones who gave them their first tobacco product, and 77% said peer pressure was the key reason they started smoking.

[Table 4] shows the percentage distribution of the study population based on the variables that influence tobacco habit continuity. More than half of the study participants (55.6%) said that habit forming was the most important factor in continuing their tobacco habit, and 96.9% reported that the availability and accessibility of tobacco products increased their chances of tobacco consumption.
Table 4: Distribution of study population based on tobacco habit continuation factors

Click here to view


The distribution of the study population based on oral cancer awareness levels is shown in [Table 5]. About three-quarters of the study population stated that they had heard of oral cancer. Tobacco causes oral cancer, according to 71.1% of the study population. Nearly 57.3% of the study participants said they did not know oral cancer could be avoided, while 2% of them declined it. It was described as a noncontagious disease by about 13% of the study population. More than half of the participants in the study had no idea that nonhealing ulcers in the mouth could be a sign of oral cancer.
Table 5: Distribution of study population based on oral cancer awareness levels

Click here to view


Around 50.4% of the study population agreed that oral cancer should be treated, and about 56.3% agreed that early detection of oral cancer would result in a good prognosis, while 43.8% said they did not know.

The association between initiation factors, cessation factors, and demographic variables is shown in [Table 6]. With P < 0.001, there was a statistically significant association between initiation and cessation factors, as well as age group, occupation, education, and socioeconomic status of participants. There was no statistically significant association between gender and initiation factors (P = 0.09), but there was a statistically significant association between gender and cessation factors (P = 0.004). With P < 0.001 and P = 0.05, respectively, there was a statistically significant association between initiation, cessation factors, and residence.
Table 6: Association between tobacco habit initiation, cessation and demographic variables

Click here to view



   Discussion Top


Tobacco use is one of the most dangerous activities that people engage all over the world. Tobacco use and second-hand smoke are responsible for approximately 6 million deaths worldwide per year.[11] Although literature establishes nicotine to be the reason for tobacco addiction, other factors responsible for initiation and cessation of tobacco habit have not been explained comprehensively. The lack of awareness about the real risks of tobacco has a huge effect on its use.[6] The factors associated with initiating and quitting tobacco have been investigated. Peer pressure and delinquent behavior were initiating factors.[12],[13],[14] Health concerns and financial stress were the main motivators for tobacco cessation.[15],[16],[17] With increasing demand among tobacco users to quit tobacco.[18] To establish effective approaches to minimize tobacco-related morbidity and mortality, it is important to first consider the all-encompassing roles of multiple factors responsible for initiation and the role of barriers in cessation.[19]

Tobacco being the prime factor in the development of oral cancer apart from habit-related information exploring awareness among tobacco users regarding oral cancer will be invaluable. Literature about the awareness regarding oral cancer in the Indian population is scarce.[9] As a result, this cross-sectional study was conducted to determine the factors that contribute to the initiation and continuation of a tobacco habit, as well as levels of oral cancer awareness among the general population.

Population-based surveys are recommended in rural areas where approximately 72% of the population reside with high illiteracy rates, low socioeconomic status, and poor access to health education hence knowledge about the ill effects of tobacco is much needed.[20] The study area of the current study was predominantly rural, with 90% of participants residing in rural areas.

Men represented 97.2%, whereas women represented 2.8% of the study population. The low proportion of female tobacco users was reported in studies done by Subba et al. and Chezhian et al., which is in line with current study findings.[21],[22] It is possible that the low proportion of female smokers is due to sociocultural stereotypes, the age group of study participants, and gender-related stigma.

The literacy rate of the Telangana state as per the 2011 census is 66.54%.[23] There were approximately an equal number of literates 51.9% and illiterates 48.1% among the participants of the current study. The proportion of illiterates was higher than state literacy might be due to the rural setting of the study.

The mean age of initiation among current study participants was found to be 20.4 years (standard deviation [SD] = 5.7). Denny et al. and Chezhian et al. reported analogous mean age of around 20 years (SD = 4) at which most of the participants started using tobacco.[19],[22] An utmost percentage of the current study population (77%) stated that peer influence was the main reason due to which they have started consuming tobacco. These findings are in concordance with findings of Naing et al.'s study where peer influence was found to be the major reason (75%) of tobacco use initiation among adolescents.[24] The current study findings are in contrast with Denny et al.'s study findings where relief from the tension (30%), followed by peer influence (18%) were reasons for initiation.[19]

Farmers perceived peer influence to be the main reason probably due to habit being considered normal in their peer network. The current study findings report that there exists a statistically significant association between age, residence, socioeconomic status, occupation, and reasons being perceived responsible for habit initiation among users. It was found that gender had no significant association with reasons for initiation reported among current study participants. This was in concordance with study reports by Escoedo LG et al. on American population where sociodemographic variables influence habit initiation[25] Duc et al. studies on tobacco initiation in Vietnamese population report similar results. Despite the fact that tobacco is now commonly known as a cancer risk factor, there are still pockets of society that are unaware of the correlation between tobacco and disease who were approximately 29% in the current study. This is in line with Aguiar et al. study where 20% have stated the same.[16] This signifies much more targeted efforts to reach the unreached sections of the community.

Limitations in this study are inherent due to its cross-sectional nature where one cannot establish a temporal association between predictors and dependent factors.

Besides limitations, the current study population was sampled from the general population which better represents the community and results can be extrapolated. Understanding the predictors of oral cancer awareness is crucial for potential educational initiatives directed at the high-risk community for oral cancer, especially tobacco users. The combined efforts of the public and private sectors, with the help of health professionals, could help raise awareness of the hazards of smoking and encourage people to participate in smoking prevention programs. Tobacco cessation strategies should take into account the multifaceted nature of tobacco initiation and cessation, especially in rural areas.


   Conclusion Top


Peer influence (77%) was the major initiating factor among tobacco users. About 41% of participants stated that they started using tobacco when they were in 19–25 years of age. Mean age of initiation was noticed to be 20.4 ± 5.7 years. About 72% of tobacco users are aware that tobacco causes oral cancer. About half of tobacco users are aware that modification of lifestyle habits reduces the risk of developing oral cancer.

Recommendations

  • Tobacco ban should be encouraged like narcotic drugs and should be comprehensive making it inaccessible to all. As the ban may affect the laborers who are working in the tobacco industry, they need to be provided any other line of work
  • Encouraging clinic-based tobacco cessation centers in rural areas is essential
  • Other avenues to investigate include different forms of stress management among tobacco consumers, which could aid in prevention and cessation.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Sharma K. Burden of non-communicable diseases in India: Setting priority for action. Int J Med Sci Public Health. 2013;2:7-12.  Back to cited text no. 1
    
2.
Rajaraman P, Anderson BO, Basu P, Belinson JL, Cruz AD, Dhillon PK, et al. Recommendations for screening and early detection of common cancers in India. Lancet Oncol 2015;16:e352-61.  Back to cited text no. 2
    
3.
Sahoo S, Suvarna S, Chandra A, Wahi S, Kumar P, Khanna G. Prevalence based epidemiological cancer statistics: A brief assessment from different populations in India. Oral Health Dent Manag 2013;12:132-7.  Back to cited text no. 3
    
4.
Joseph BK. Oral cancer: Prevention and detection. Med Princ Pract 2002;11 Suppl 1:32-5.  Back to cited text no. 4
    
5.
Kendler KS, Myers J, Damaj MI, Chen X. Early smoking onset and risk for subsequent nicotine dependence: A monozygotic co-twin control study. Am J Psychiatry 2013;170:408-13.  Back to cited text no. 5
    
6.
Singh A, Ladusingh L. Prevalence and determinants of tobacco use in India: Evidence from recent Global Adult Tobacco Survey data. PLoS One 2014;9:e114073.  Back to cited text no. 6
    
7.
Anjum MS, Reddy P, Monica M, Yadav K, Abbas I, Kanakamedala S. Dental Students attitude towards tobacco cessation in and around the dental colleges of Hyderabad – A cross sectional survey. Web med Central Dent 2014;5:WMC004730.  Back to cited text no. 7
    
8.
Anjum MS, Srikanth MK, Reddy PP, Monica M, Rao KY, Sheetal A. Reasons for smoking among the teenagers of age 14–17 years in Vikarabad town: A cross-sectional study.J Indian Assoc Public Health Dent 2016;14:80.  Back to cited text no. 8
  [Full text]  
9.
Jager W. Breaking bad habits: A dynamical perspective on habit formation and change. In: Human Decision-Making and Environmental Perception – Understanding and Assisting Human Decision-Making in Real-Life Settings. Libor Amicorum for Charles Vlek, Groningen: University of Groningen; 2003.  Back to cited text no. 9
    
10.
GATS 2009-10 World Health Organization, Regional Office for Southeast Asia. Global Adult Tobacco Survey (GATS): India Country Report. New Delhi: WHO- SEARO; 2009. Available from: http://www.searo.who.int/india/mediacentre/events/2017/gats2-india.pdf. [Last assessed on 2017 Oct 20].  Back to cited text no. 10
    
11.
Duc DM, Vui LT, Son HN, Minh HV. Smoking initiation and cessation among youths in Vietnam: A longitudinal study using the Chi Linh Demographic-Epidemiological Surveillance System (CHILILAB DESS). AIMS Public Health 2017;4:1-8.  Back to cited text no. 11
    
12.
Parkin DM, Läärä E, Muir CS. Estimates of the worldwide frequency of sixteen major cancers in 1980. Int J Cancer 1988;41:184-97.  Back to cited text no. 12
    
13.
Kandel DB, Kiros GE, Schaffran C, Hu MC. Racial/ethnic differences in cigarette smoking initiation and progression to daily smoking: A multilevel analysis. Am J Public Health 2004;94:128-35.  Back to cited text no. 13
    
14.
Griesler PC, Kandel DB, Davies M. Ethnic differences in predictors of initiation and persistence of adolescent cigarette smoking in the National Longitudinal Survey of Youth. Nicotine Tob Res 2002;4:79-93.  Back to cited text no. 14
    
15.
Aubin HJ, Peiffer G, Stoebner-Delbarre A, Vicaut E, Jeanpetit Y, Solesse A, et al. The French Observational Cohort of Usual Smokers (FOCUS) cohort: French smokers perceptions and attitudes towards smoking cessation. BMC Public Health 2010;10:100.  Back to cited text no. 15
    
16.
Aguiar M, Todo-Bom F, Felizardo M, Macedo R, Caeiro F, Sotto-Mayor R, et al. Four years' follow up at a smoking cessation clinic. Rev Port Pneumol 2009;15:179-97.  Back to cited text no. 16
    
17.
Sieminska A, Buczkowski K, Jassem E, Lewandowska K, Ucinska R, Chelminska M. Patterns of motivations and ways of quitting smoking among Polish smokers: A questionnaire study. BMC Public Health 2008;8:274.  Back to cited text no. 17
    
18.
GATS 2016-17 World Health Organization, Regional Office for South-East Asia. Global Adult Tobacco Survey (GATS): India Country Report. New Delhi: WHO- SEARO; 2009. Available from: https://www.who.int/tobacco/surveillance/survey/gats/GATS_India_2016-17_FactSheet.pdf. [Last accessed on 2016 Oct 20].  Back to cited text no. 18
    
19.
Denny C, Priya J, Thattil B, Ongole R, Ahmed J, Binnal A, et al. Psychological factors influencing initiation and cessation of tobacco habit among Indian population – A cross-sectional study. J Res Med Den Sci 2014;2:32-7.  Back to cited text no. 19
    
20.
Rekha B, Anjum S. Effectiveness of pictorial warnings on tobacco packs: Hospital-based study findings from Vikarabad. J Int Soc Prev Community Dent 2012;2:13-9.  Back to cited text no. 20
    
21.
Subba SH, Binu VS, Menezes RG, Ninan J, Rana MS. Tobacco chewing and associated factors among youth of Western Nepal: A cross-sectional study. Indian J Community Med 2011;36:128-32.  Back to cited text no. 21
[PUBMED]  [Full text]  
22.
Chezhian C, Murthy S, Prasad S, Kasav JB, Mohan SK, Sharma S, et al. Exploring factors that influence smoking initiation and cessation among current smokers. J Clin Diagn Res 2015;9:C08-12.  Back to cited text no. 22
    
23.
Statistical Yearbook 2016 Telangana. Available from: http://ecostat.telangana.gov.in/PDF/PUBLICATIONS/Statistical_year_book_2016.pdf. [Last accessed on 2017 Jun 21].  Back to cited text no. 23
    
24.
Naing NN, Ahmad Z, Musa R, Hamid FR, Ghazali H, Bakar MH. Factors related to smoking habits of male adolescents. Tob Induc Dis 2004;2:133-40.  Back to cited text no. 24
    
25.
Escobedo LG, Anda RF, Smith PF, Remington PL, Mast EE. Sociodemographic characteristics of cigarette smoking initiation in the United States. Implications for smoking prevention policy. JAMA 1990;264:1550-5.  Back to cited text no. 25
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
   Conclusion
    References
    Article Tables

 Article Access Statistics
    Viewed213    
    Printed4    
    Emailed0    
    PDF Downloaded35    
    Comments [Add]    

Recommend this journal