Abstract
India has one of the highest rates of oral cancer in the world2. Tobacco is one of the most common hazardous substance for general health as well as oral health. The use of tobacco in any form increases the risk of oral cancer.
To assess the knowledge regarding the harmful effects of betel quid, areca nut and tobacco among the general population of Guntur city and understanding regarding oral cancer risk. To assess the reasons for the consumption of betel quid, areca nut and tobacco.
A descriptive cross sectional questionnaire survey was conducted among general population of Guntur city and 600 persons were assessed for the evaluation of habits of smoking and chewing tobacco. The study consists of sample of convenience. Standard questionnaire was developed which elicited details of samples and information about tobacco chewing practices.
Prevalence of betel quid, areca nut and tobacco habits among general population of Guntur is high. 81.67% respondents consume tobacco either in smoke or smokeless form. 7.53% consume betel quid and 5% consume areca nut 6% consume tobacco, betel quid and areca nut in combination. Among the Guntur city population there is general lack of awareness regarding risk factors of oral cancer.
Key words: Tobacco, Betel quid, Areca nut, Oral cancer
Introduction
Tobacco is one of the most common hazardous substance for general health as well as oral health. It is used in various forms like smoked tobacco such as cigarettes, chutta, beedi, hookah, and smokeless tobacco which includes gutkha, snuff, paan, zarda etc.
Betel quid is a combination of betel leaf,areca nut and slaked lime. In India, tobacco is added to this mixture and the product is known as gutka, the association of this to paan is associated with significant increase for development of oral cancer. It causes oral cancers predominantly carcinomas of lip, mouth, tongue, pharynx. Presence of lime within paan that could contribute to cytogenic damage involved in the eitiology of oral cancer.
Areca nut contain three main alkaloids arecoline, arecain and guvacaine which are the main etiological factors for causing oral submucous fibrosis, which is a predominant precancerous condition.
Among the total world population nearly about 17.6% are tobacco users. In India, about 33% of the total population are tobacco users in one or the other forms. According to “National Family Health Survey III about 57% of males and 11% of females are tobacco users in India.[1] In 17 of 29 states of India, tobacco users are more than 69% and Andhra Pradesh is one of such states. 90% of oral cancers are directly attributed to chewing and smoking tobacco.[1] India has one of the world’s highest incidence of oral cancer equal to one-third of the cancers. Most of the people suffering from precancerous and cancerous conditions are addicted with habits of chewing tobacco, betel quid, arecanut and smoking tobacco.
Guntur, a town on the east coast, of Andhra Pradesh with its population of 5.1lakh, is a centre of learning and administrative capital of Guntur district and the region is centre for business, industries mainly agriculture – tobacco, chillies, cotton etc
No study has been conducted in Guntur population regarding these habits, hence survey has been designed to assess the betel quid, areca nut, tobacco habits and understanding of oral cancer risk among general population of Guntur city.
Objectives
1. To assess the knowledge regarding the harmful effects of betel quid, areca nut, tobacco among general population of Guntur city and understanding regarding oral cancer risk.
2. To assess the reasons for the consumption of betel quid, areca nut and tobacco.
3. To assess the prevalence of habits among general population of Guntur city.
Materials and methods
A descriptive cross sectional questionnaire survey was conducted among general population of Guntur city and 600 persons were assessed for the evaluation of habits like smoking and chewing tobacco. The study used a sample of convenience technique. A pretested questionnaire was developed which elicited details of samples and information about tobacco chewing practices.
Samples were selected from bus stand, railway station, tea shops, canteen, general hospitals, shopping centres etc. Samples consisted of males of all age groups. The subjects who are voluntarily interested to participate were included in this study and the population who are not willing to participate and those without habits were excluded.
Prior to the start of the study ethical clearance was obtained from ethical committee of SIBAR institute of dental sciences, Takkellapadu, Guntur. The duration of study spanned over a period of 45 days.
A pilot study was conducted among few subjects using proforma to know the feasibility of study. Before collecting the data, consent form was obtained from the participants the study. The proforma, was designed such that it consists of questionnaire in English along with local language telugu for ease.
Proforma consists of recording general information including name, age, sex etc. ,
information about duration, frequency, type of tobacco and reasons for consumption of betel quid, areca nut, tobacco, understanding of mouth cancer risk.
To prevent bias in the study third person assistance was taken to screen illiterate subjects.
SURVEY PROFORMA
B.S.P NO
1. Name:
2. Age :
3. Gender :
a. Male b. Female
4. Religion :
a. Hindu b. Muslim c. Christian
5. Address :
6. Phone No. . :
7. Consumption :
a. Betel quid b. Areca Nut c. Tobacco
8. Frequency :
a. Daily b. Weekly Once c. Occassional
9. How did you start the habit?
a. Influence by friends & relatives
b. Thrill
c. Anxious to try it
10. Reasons for Consumption :
a. Habit b. Pleasure c. Style d. Stress e. Influence by Movies
11. Type of Tobacco Consumption :
a. Chewing b. Smoking c. Both
12. No. of Cigarettes per Day
13. Tobacco Packets per Day :
14. Have you heard about oral cancer:
a. Yes b. No
15. Source of Knowledge of Oral Cancer :
a. School b. Press c. Doctor d. Other
16. Which one is harmful among these :
a. Betel quid b. Areca nut c. Tobacco
17. Form of Tobacco which is harmful :
a. Chewing b. Smoking c. Both
18. If diagnosed as Pre-Cancer then :
a. Stop b. Continue the Consumption
19. Do you observed any white or red lesion in your oral cavity :
a. Yes b. no
20. Do you feel discomfort during taking food :
a. Yes b. No
21. How much Confident to stop habit :
a. 50% b. 75% c. 100% d. Not at all:
22. Are you aware of the recent law that Bans' smoking in public places:
a. Yes b. No
23. What according to you is the right way to quit habit :
a. Health counseling b. Yoga c. Will Power d. Family Intervention e. Medical Intervention f. Media Influence
I was explained about the study by interns from the department of community dentistry sibar institute of dental sciences and I willingly participate in study.
Signature
STATISTICAL ANALYSIS:
Z test was used for proportion for categorical data and for evaluation of mean of data ANOVA test was used.
Results
The study was conducted to determine use of betel quid, areca nut, tobacco among general population of Guntur.
* Table 1: Shows the distribution of study subjects according to their age . 25.67% observed in 29-38years; followed by 24.83% in 19-28yrs age group; 21% are in 39-48yrs; 15.83% in 49-58yrs;7.83% in 59-68 yrs and only 4.83% in 69yrs and above.
* Table 2: Shows the distribution of study subjects according to religion. 80.67% Hindus, 15.50% Muslims and 3.83% Christians.
* Table 3: Shows the distribution of study subjects according to betel quid areca nut and tobacco habits 81.67% respondents consume tobacco either in smoke or smokeless form, 7.33% respondents consume betel quid and only 5% consume areca nut and 6% of population consume combination of areca nut betel quid and tobacco.
* Table 4: Shows the distribution according to how did they start the habit ,majority of them(88.83%) has responded that they started the habit by the influence of friends and relatives,(8.33%) started for thrill, (2.83%) were anxious to try it.
* Table 5: Shows the distribution of study subjects according to reason for consumption, majority of them (40.83%) responded that main reason to consume was habit followed by (37.17%) consumed to relieve stress and only 0.67% responded that they were influenced by movies.
* Table 6: Shows the distribution of study samples according to type of tobacco consumption. Majority of them 62.67% were using smoking form of tobacco, 26.50% were using only chewing form of tobacco and remaining 10.83% were using both form of tobacco.
* Table 7: Shows distribution of study subjects according to number of cigarettes per day, . 83% of population smokes tobacco on an average 11 cigarettes per day and alsoShows the distribution of study subjects according to the number of tobacco packets per day, a 6.50% of population consume on an average 8 tobacco packets per day and also
* Table 8: Shows the distribution of study samples according to the answer given by them for the question “have you heard about oral cancer?” 64.17% subjects were aware of oral cancer and 35.83% subjects do not have knowledge about oral cancer.
* Table 9: Shows the distribution of study samples according to answer given by them for the statement “if diagnosed as pre cancer then?,” 92.67% of respondents will stop the consumption of the habit ,if diagnosed as pre cancer or cancer, 7.33% respondents answered that they will continue the consumption of the habit. .
* Table 10: Shows the distribution of study subjects according to answer given by them for the statement “how much confident to stop the habit” about 62.0% subjects responded that 50% are confident ; 4.83% responded that they are 75% confident; 10.5% subjects were not at all confident to stop the habit.
* Table 11: Shows the distribution of study subjects according to the answer given by them for the statement “are you aware of recent laws that bans smoking in public places and has it affected you” 84.83% respondents are aware of this law and only 15.17% respondents are not aware of this law.
* Table 12: Shows the distribution of study subjects according to the answer given by them for the statement “what according to you is the right way to quit the habit” 75%respondents felt that medical intervention is the best way to quit the habit; about 18.33% felt that family intervention is the best to quit the habit and only 0.83% felt that health counselling is the right way to quit the habit.
Discussion
The study was conducted to evaluate the use of betel quid, areca nut and tobacco and knowledge and attitudes towards oral cancer risk factors and prevention among general population of Guntur.
Consuming tobacco and their products either in smoke or smokeless form is high (81.67%) in present study, which may be attributed to stress relieving characteristic of nicotine. As compared to the study conducted by Dr. Nagpal R et al usage of tobacco in chewing form was about 46.3% , in smoking form was about 15.4% and in both was 16.3%.[5]
In the age group of 19-28 years---76.51% respondents were with the habit of tobacco, 7.38% of people were with the habit of betel quid and 9.40% were with the habit of areca nut.
Habits of Hindus were found to be very high (78.5%) where as Muslims it was low (18.12%) and among Christians only 3.36% , this is consistent with the study conducted by Dr.Jagadish Chandra et al among general population of Gulbarga city.[2]
On evaluation it was found that 88.8% population started the habit of betel quid, areca nut and tobacco under the influence of friends which is little high when compared to study conducted by Dr.Jagadish Chandra et al among general population of Gulbarga city.[2]
In this study smoking form of tobacco without betel quid and areca nut was 62.6% which was high when compared to (45.8%) study conducted by Dr.Sharma et al in Udaipur city.[4]
About 64% of respondents were aware of oral cancer out of which only 22.67% of population were willing to stop the habit, this may be because of easy availability of betel quid, areca nut, tobacco and also improper knowledge in prevention and avoiding the habits.
In the present study 84.83% of the respondents are aware of the recent law that ban smoking places which was high when compared to study conducted by Dr.Jagadish Chandra et al among general population of Gulbarga city.
Conclusion
First time such kind of study was conducted in Guntur has provided valuable information on present use of betel quid, areca nut and tobacco and knowledge and attitudes of population towards oral cancer risk factors.
On evaluation of study we can conclude that because of general lack of awareness about the risk factors of oral cancer, the prevalence of use of tobacco, areca nut and betel quid was high. To overcome the defeciencies of knowledge, we can provide appropriate education and propaganda on aspect of betel quid, areca nut and tobacco use.
Recommendations
As it is evident that considerable percentage of population use tobacco, betel quid, areca nut urgent regulatory actions are needed to control the manufacturing, marketing and consumption of betel quid, areca nut and tobacco products.
Educate and increase the awareness among the population about the effects of tobacco, betel quid and areca nut on general health and oral health.
Counselling by health professionals is an effective method in guiding patients towards tobacco cessation. Promoting tobacco cessation clinics in all public and private hospitals.
People should be encouraged for attending antitobacco cells.
Acknowledgements
Our sincere thanks to staff and students of public health dentistry for their valuable support. We also thank our college management (Sibar institute of dental sciences) for their valuable support.
References
1. Advocacy forum of tobacco control-Statistics on tobacco use.
aftcindia.org/stat_tob_use-html
2. Dr. Jagadish Chandra etal. Betel quid, areca nut, tobacco habits and understanding of oral cancer risk among general population of Gulbarga city, Karnataka. JIAPHD 2009:14:114-121
3. Dr. Naveen Baratam etal. Tobacco related attitudes and counselling practices among dental surgeons in Chennai. JIAPHD 2008:12:34-39.
4. Dr. Swathi etal. Factors related to tobacco use among urban and periurban population of Udaipur city.JIAPHD 2008:11:10-12.
5. Dr. Ruchi n etal. Prevalence of Oral Mucosal lesions in tobacco and alcohol using population of Lucknow city: A Hospital based study. JIAPHD 2008:12:45-51
6. Dr. Suresh babu AM et al. Tobacco habits, attitudes abd prevention among 500 dental professionals of two dental colleges in Davanagere city. JIAPHD 2006:7:25-29.
7. Dr. chandrasekaran etal. Awareness of ill effects of smoking among male patients of SBDC & H. JIAPHD2005; 5:7-13.
Source(s) of Funding
None
Competing Interests
None
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