Background: Tobacco use is one of the important preventable causes of death and a leading public health problem all over the world. Globally, it kills nearly 7 million people. If current trends continue, by 2030 tobacco use is estimated to kill more than 8 million people worldwide each year. The present study was carried out to determine prevalence and pattern of tobacco usage among urban slum dwellers of Burla NAC. Materials and Methods: A community based cross-sectional study was conducted in urban slums of Burla, NAC under the field practice area i.e. Urban Health & Training Centre of VIMSAR, Burla. 350 participants were selected by simple random sampling among adults aged 18 years and above. Results: 48.2% were using some or other forms of tobacco. Among users,62.4% were consuming smokeless form while 12.9% were consuming smoking form & 24.7% were using both forms. Most of the tobacco users were in the age group of 38-47 years. Males outnumbered females in all the three forms of tobacco use. Prevalence of current tobacco users is 41% of which 18% are daily users. The commonest cause for starting tobacco was to pass time (21%) and peer pressure (19.8%). Cigarettes (7.4%) and Bidis (8.3%) were common smoking forms of tobacco. Most common smokeless form of tobacco consumed were Gutkha (14.86%) and Khaini (11.7%). Conclusions: We observed a high prevalence of tobacco usage as compared to national average. A focussed and effective health education strategy is needed according their age, gender and education status to increase the knowledge and awareness about harmful effects of tobacco and its products in urban slums of Burla.
Tobacco use is the biggest menace to mankind. It costs not only human lives but also heavy social and economic loss. According to World Health Organisation (WHO) it’s use claims about 7 million lives across the globe1. India is the second largest consumer and third largest producer of tobacco. According to Global Adult Tobacco Survey (GATS-1) 2009-10, nearly 275 million adults (15 years and above) are under the clutches of tobacco products2. In the present scenario where the rate of deaths due to non-communicable diseases is on an alarming rise, tobacco consumption is an aggravating factor. Every year 0.9 million deaths and 12 million people fall ill due to tobacco consumption3. In this time of modern medicine science and technology, though humans are trying their best to combat cancers but still India has one of highest rates of lip and oral cavity cancers in the world4.
The second round GATS (GATS-2) in 2016-17 by WHO and Union Ministry of Health, revealed that though smoking has dropped during the period but the percentage of smokeless tobacco such as khaini, gutkha, pan masala consumers has not changed in Odisha. The percentage of smokeless tobacco consumers in Odisha is double the national average. The annual health survey of 2012 by Register General and census commissioner shows Odisha tops the list among tobacco chewer states of Assam, Chhattisgarh, UP, MP, Rajasthan5.
As per 2011 census, Burla NAC caters a population 46,698 and the majority are urban slum dwellers5. The people residing in urban slums are usually neglected and underprivileged without basic facilities and services. They are more prone to practice risk behaviours because of poor housing and neighbourhood environment, risky lifestyles, lack of health knowledge, and poor physical and psychosocial health6. The studies on socio-economic background of tobacco consumers have found that tobacco consumption is higher among socially disadvantaged and low income groups7. So, the present study was conducted in this locality with an objective to determine prevalence of tobacco usage and patterns among urban slum dwellers of Burla.
It was a community based cross-sectional study conducted in urban slums in the field practice area of Urban Health & Training Centre under Community Medicine Department of Veer Surender Sai Institute of Medical Science and Research (VIMSAR), Burla for a period of 4 months from July to October 2017.
Sample size calculation: Taking the prevalence of tobacco use among adults to be 35%, with an absolute precision of 5%, the minimum required sample size for assessing the prevalence of tobacco use among adults was calculated as 350 by using formula n= (1.962) p q / (l2). Inclusion criteria: Persons with age 18 years and above were included in the study. Exclusion criteria: Very sick, mentally unsound persons and those not willing to participate were excluded from the study.
Selection of study participants- A total of 350 families was selected from the enlisted household of the area by using simple random sampling method. Then from every household one person was randomly selected who matched the inclusion and exclusion criteria.
Data collection method- After obtaining verbal consent, data was collected by interviewing selected persons using a modified semi-structured questionnaire adopted from GATS (Global Adult Tobacco Survey) questionnaire 2009-10.
Data analysis- After collection, data was compiled & tabulated by using MS Excel Sheet & the result obtained was expressed in terms of simple number & percentage.
Ethical permission- The study was conducted after ethical clearance of institutional ethical committee (VIREC, Burla).
Table 1: Socio-demographic profile of study participants (n=350)
|
Characteristics |
Number (N) |
Percentages (%) |
|
Age in years 18-27 28-37 38-47 48-57 ≥58 |
71 92 100 47 40 |
20.2 26.3 28.6 13.4 11.5 |
|
Sex Male Female |
193 157 |
55.2 44.8 |
|
Education Illiterate Primary Secondary Higher secondary Graduate |
31 64 157 66 32 |
8.8 18.3 44.9 18.8 9.2 |
|
Occupation Student Employed Unemployed Retired employed House-wife |
23 212 15 4 96 |
6.5 60.7 4.3 1.1 27.4 |
Table1 shows that most of the participants belongs to age group 38-47yrs (28.6%), followed by 28-37yrs (26.3%),18-27yrs (20.2%),48-57yrs (13.4%) & >58yrs (11.5%) respectively. 55.2% Among the study participants were males & 44.8% were females. Most of the participants belongs to secondary education (44.9%) followed by higher secondary (18.8%), primary (18.3%), graduate (9.2%) & illiterate (8.8%) respectively. So far occupation is concerned; most participants were employee (60.7%), followed by house wives (27.4%), students (6.5%), un-employed (4.3%) & retired employee (1.1%) respectively.
Table 2. Prevalence of Tobacco Usage among study participants (n=350)
|
Characteristics
|
|
Non-Users (n=180) N (%) |
Tobacco Users (n=170) |
Total |
||
|
Smokeless Form Only N (%) |
Smoking Form Only N (%) |
Both Forms N (%) |
||||
|
Age (Years) |
18-27 28-37 38-47 48-57 58&above |
49(27.2) 44(24.4) 52(28.8) 21(11.6) 14(7.7) |
12(11.3) 25(23.5) 30(28.3) 19(17.9) 20(18.8) |
5(22.7) 6(27.2) 7(31.8) 1(4.5) 3(13.6) |
5(11.9) 17(40.4) 11(26.1) 6(14.2) 3(7.1) |
71 92 100 47 40 |
|
Sex |
Male Female |
65(33.6) 115(63.8) |
68(64.15) 38(35.85) |
20(90.9) 2(9.1) |
40(95.3) 2(4.7) |
193 157 |
|
Education |
Illiterate Primary Secondary Higher sec. Graduated |
9(5) 26(14.4) 81(45) 43(23.8) 21(11.6) |
14(13.2) 29(27.3) 41(38.6) 13(12.2) 9(8.4) |
2(9.1) 2(9.1) 12(54.5) 5(22.7) 1(4.5) |
6(14.2) 7(16.6) 23(54.7) 5(11.9) 1(2.3) |
31 64 157 66 32 |
|
Occupation |
Student Employee Unemployed Retired Housewife |
15(8.3) 92(51.1) 1(0.5) 1(0.5) 71(38.8) |
5(4.7) 73(68.8) 8(7.5) 5(4.7) 15(14.1) |
1(4.5) 13(59.0) 2(9.1) 1(4.5) 5(22.7)
|
2(4.7) 34(80.9) 3(7.1) 2(4.7) 1(1.7)
|
23 212 14 9 92
|
Table 2 revealed that, out of 350 study participants, 170(48.2%) were using some or other forms of tobacco. Among users,106 (62.4%) were consuming smokeless form while 22 (12.9%) were consuming smoking form & 42 (24.7%) were using both forms. Most of the tobacco users were in the age group of 38-47 years which contributes 28.3% of the smokeless form, 31.8% of the smoking form & 26.1% of both the forms. The age group from 28-37 yrs also contributing a greater part in use of tobacco in different forms i.e. 23.5% of smokeless,27.2% smoking and 40.4% both forms respectively.
Male contributes 33.6% of the non-users & 64.15% of the users consuming smokeless form, 90.9% of the users consuming smoking form & 95.3% of the users consuming both the forms. Whereas the Female contributes 66.3 % of the non-users & 35.85% of the users consuming smokeless form, 9.1% of the users consuming smoking form & 4.7% of the users consuming both the forms.
Considering education as a characteristic most of the tobacco users belong to the secondary education group which contributes 45% of the non-users & 38.6% of the users consuming smokeless form, 54.5% of the users consuming smoking form & 54.7% of the users consuming both the forms.
So far occupation is concerned, most of the tobacco users belong to the employee group. It contributes 51.1% of the non-users & 68.8% of the users consuming smokeless form, 59.0% of the users consuming smoking form & 80.9% of the users consuming both the forms.
Table 3. Pattern of smoking form of tobacco usage among study participants (n=22)
|
Pattern of Smoking |
Male N (%) |
Female N (%) |
Total N (%) |
|
Cigarette |
6(30.0) |
0 |
6(27.2) |
|
Bidi |
9(45.0) |
2(100.0) |
11(50.0) |
|
Ganja |
5(25.0) |
0 |
5(22.7) |
|
Total |
20(90.9) |
2(9.1) |
22(100) |
Table 3: Shows that among all the male respondents consuming smoking form of tobacco, 45% were using Bidi, 30% were cigarette & 25% were using Ganja. Whereas among the female respondent all were found to be consuming Bidi only.
Table 4. Pattern of smokeless form of tobacco usage among study participants (n=106)
|
Pattern of smokeless form |
Male N (%) |
Female N (%) |
Total N (%) |
|
Pan Masala |
16(23.5) |
6(15.7) |
22(20.7) |
|
Betel quid with tobacco |
8(11.7) |
7(18.4) |
15(14.1) |
|
Gutkha |
32(47) |
7(18.4) |
39(36.7) |
|
Khaini |
12(17.6) |
18(47.3) |
30(28.3) |
|
Total |
68(64.1) |
38(35.9) |
106(100) |
Table 4: Shows that among all the respondents consuming smokeless form of tobacco, gutkha & khaini were found to be the most common. Among them 47% of the males were using gutkha & 47.3% of the female were using khaini.
In this study, out of 350 study participants majority were in the age group of 18-47yrs (75.10%). Males & females were almost same in number. Most of the participants belong to secondary education (44.9%) and were employed (60.7%). Amongst all the participants, 48.6% were tobacco users. GATS-1(2009-10) and GATS-2 (2016-17) showed that the prevalence of tobacco use among Indians was 34.6% and 28.6% respectively. Hence the usage of tobacco among our study participants is higher as compared to the national average tobacco usage 2,10,12.
In this study, we observed that smokeless tobacco use is higher in selected urban slums followed by both forms of tobacco use as compared to smoking form. Similar findings reported in urban slums of Jodhpur city that prevalence of smokeless tobacco use was more than other forms of tobacco consumption16. This may be attributed to the availability and affordability of different forms of smokeless tobacco in India and this will make the smokeless tobacco easily available for socially underprivileged people. Contradictory to our study a study conducted by Teena M Joy et.al. in urban slums of Kochi, Kerala observed that all the persons identified as tobacco users were tobacco smokers and no one were using smokeless form of tobacco17.
In our study, males were outnumbered females in all the three forms of tobacco use i.e. smokeless (64.15% vs 35.85%), smoking (90.9% vs 9.1%) and dual forms 95.3% vs 4.7%) higher than the females. Most of the smokers and dual form users were males. Similar findings were observed by Joshi V et al in their study in Jodhpur city16.
The most common reason for initiation of tobacco usage is “to pass time” (21%) & “peer pressure” (19.3%) but in a similar study conducted by C. Althaf Hussain et al, showed that the most common reason for initiation of tobacco usage was “offered in occasions” and “peer pressure”8. But Teena M Joy et.al. noted most common reason for initiation of tobacco usage were to pass time (40.4%) and peer pressure (21.2%)17. Present study revealed that 27.3% male & 7.8% female are daily users of tobacco, 29.47% male & 2.4% females use daily smoking form of tobacco. 36% males & 26% females use daily smokeless form of tobacco & 21% males & 1% females consumed both forms daily. Similar study by Das R et al, showed that among urban slums 48.3% of male and 11.9% of female are daily tobacco users, ,40.8 % male &11.9 % females use daily smoking form of tobacco. 10.5% males & 3% females use daily smokeless form of tobacco & 3% males & 0.2% females consumed both forms daily9.
In our study, most of the tobacco users belong to the age group (38-47) years which contribute 28.3% of the smokeless form, 31.8% of the smoking form & 26.1% of both the forms. However, In GATS-1, 45-65 years age group of people were found to consume maximum tobacco compared to other age groups2. Among the male participants, 42.4% are ever users, 14.4% current daily users, 7.2% current occasional users, 2% former users and 33.6% are non-users of tobacco. Similarly, in female group 12.7% are ever users, 5.1% current daily users, 6.3% current occasional users, 2.5% former users and 63.8% are non-users of tobacco. The pattern of smoking among male participants were i.e. Bidi (45%), Cigarette (30%) and Ganja (25%) respectively whereas the female participants were found to be consuming Bidi only. Similar findings were observed by Joshi et al in urban slums5 of Jodhpur city 16.
In this study, Gutkha and Khaini was the most common smokeless form of tobacco consumed by the participants. Gutkha was used by 47% males and Khaini was used by 47.3% female. A study conducted by Joshi et al in urban slums of Jodhpur city also observed that tobacco use in smokeless form (gutka/Zarda) is more prevalent in urban slum population15. GATS 2 also observed that khaini - a tobacco, lime mixture- is the most commonly used tobacco product in India14. Our study also revealed television as the most potent tool to gather anti-tobacco information as expected followed by warning label on the tobacco products, newspapers, cinemas & medical professionals. Similar findings were also observed during GATS 2 14.
Our study revealed a higher usage of tobacco as compared to the national average. Although the usage of different forms of tobacco is observed to be more in some particular age, gender, education and occupation groups but more or less it has been observed in all the groups. This indicates the need of comprehensive health education program for tobacco cessation in our study area. So, information, education and communication (IEC) activities is necessary among the slum population with focus on different education needs according their age, gender and educational and occupational status. We also found higher percentages of smokeless tobacco users compared to other forms. Male outnumbered females in using all forms of tobacco usage. It also emphasizes the more focused need of health education intervention in context to male. A focussed and effective health education strategy is necessary to increase the knowledge and awareness about harmful effects of tobacco and its products in the slum population of Burla NAC. Prevention of tobacco usage in the world today is most important opportunity to prevent NCDs i.e. cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. The National tobacco control programme needs to adopt a more holistic & coercive approach to fight the problem of tobacco by adopting media awareness, behaviour change and communication, different interventional activities & establishing tobacco de-addiction & counselling centres for slum dwellers. Not only the government but all responsible citizens will need to support the fight against tobacco consumption.
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11. Report of the committee on slum statistics/census, government of India ministry of housing and urban poverty alleviation national buildings organization New Delhi. Available from http://nbo.nic.in/images/pdf/report_of_slum_committee.pdf
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15. Joshi V, Joshi NK, Bajaj K. Tobacco use pattern, dependence, oral cancer awareness and health education needs among urban slum dwellers of Jodhpur city. Int J Prev Med 2022; 13:14.
16. Joshi V, Chakraborty S, Joshi NK, Bajaj K, Sati B, Purohit A. Smokeless tobacco and its dependence among the urban-slum population of Jodhpur city. Int J Community Med Public Health 2021; 8:1186-90.
17. Teena M Joy, Sreelakshmi M, Nimitha P, K Leelamoni.Prevalence of Tobacco Use in an Urban Slum. National Journal of Research in Community Medicine. 2017;6(2):110-115
18. Manori Dhanapriyanka. Tobacco Using Behaviour among Youth Residing in Urban Slum Areas in Sri Lanka. 2nd International Conference on Public Health and Well-being 2021; 11(1):23-32
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