Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 6  |  Issue : 2  |  Page : 161-164  

Socio demographic factors associated with tobacco use in rural Maharashtra


Department of Community Medicine, MIMER Medical College, Talegaon Dabhade, Maharashtra, India

Date of Web Publication10-Apr-2013

Correspondence Address:
Ratna Majumdar
Flat No 6, Asters Apartment, Road No. 3B, Kalyani Nagar, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.110303

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  Abstract 

Background: The epidemic of tobacco use is shifting from developed to developing countries, where increased use is expected to result in a large disease burden in the future. Findings from countries of SEAR reveal that tobacco use is higher among the rural, illiterates, and poor population. Aims: To assess use of tobacco in various groups of people and awareness regarding its ill effects in rural Maharashtra. Setting and Study Design: Urban health center of MIMER Medical college, Cross sectional. Materials and Methods: The survey was conducted in field practice area of urban health centre near Pune, Maharashtra. The estimated sample size was 378 with α = 0.05 and 80% power of test. Alternate families were selected by systematic random sampling. All the family members between the age group 15 and 75 years of the selected family were included in the sample. Data was collected using a pre-tested pre-validated questionnaire. Statistical Analysis Used: Data was analyzed using the chi-square test. Results: The study population comprised of 426 people. Percentage of tobacco users decreased with an increase in level of education and the difference was statistically significant (χ2 = 54.56; P < 0.0001). Type of tobacco use differed with sex and education but not with age. Peer pressure turned out to be the major cause (80.5%) for starting the use of tobacco, followed by influence of family members (11.2%). Percentage of female tobacco users was found to be on higher side in this population as compared to other studies. Conclusion: Thus, effective measures are needed to address the uneducated female population of rural India, in order to decrease the use of tobacco significantly.

Keywords: Awareness, ill effects, prevalence, rural, tobacco


How to cite this article:
Majumdar R, Raje SS, Dandekar A. Socio demographic factors associated with tobacco use in rural Maharashtra. Med J DY Patil Univ 2013;6:161-4

How to cite this URL:
Majumdar R, Raje SS, Dandekar A. Socio demographic factors associated with tobacco use in rural Maharashtra. Med J DY Patil Univ [serial online] 2013 [cited 2022 Jun 26];6:161-4. Available from: https://www.mjdrdypu.org/text.asp?2013/6/2/161/110303


  Introduction Top


Tobacco is the most important risk factor causing non-communicable disease. Nearly six million people die each year from tobacco use and are exposed to smoke worldwide. [1] The young people are particularly vulnerable. [2] Tobacco use and its pattern are closely linked to age, sex, social class, education, income, etc among many other factors. Findings from countries of SEAR reveal that tobacco use is higher among the rural, illiterate, and poor population. [3] Use of smokeless tobacco by the rural population and lower socio-economic groups leads to high disease burden, so smokeless tobacco needs special attention. [4]

The present study was carried out to assess the use of tobacco in various groups of people of different age, sex, occupation, and education in rural Maharashtra and to elicit awareness regarding ill effects of tobacco use.


  Materials and Methods Top


A cross-sectional study was conducted in field practice area of urban health center of MIMER Medical College, Talegaon Dabhade, near Pune, Maharashtra. Considering reported prevalence of 38% in rural India, [3] the estimated sample size was 378, at 95% confidence interval and 80% power of test. As the total number of families registered at UHC was 900, multistage sampling was done where in a systematic sample of every alternate family was included in the first stage. In the second stage, all the family members between the age of 15 and 75 years, who agreed to participate in the study, were included in the sample after obtaining their oral consent. Data was collected by a bilingual questionnaire, which was filled by the participants on spot during family visits.


  Results Top


The study population comprised of 426 people between the age group 15 and 75 years, out of which 275 (64.55%) were males and 151 (35.45%) were females. Nearly 198 (46.5%) of the population reported that they use tobacco in some form and the number of male tobacco users (155) was significantly more than that of females (43) (z = 5.87 P < 0.001).

[Table 1] shows distribution of tobacco users according to their age and sex. It was observed that significantly less (4 (14.8%)) people from younger age groups used tobacco. Use of tobacco is seen to be increasing significantly with increase in age till the age of 50 and decrease thereafter. Highest percent (30 (90.9%)) of tobacco users among males was observed in the age group 40-50 years and was statistically significant χ2 = 649.38; P < 0.001). Percentage of female tobacco users significantly increased with increasing age (χ2 =1144.8; P<0.00001).
Table 1: Distribution of Tobacco Use with Respect to Age and Sex


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[Table 2] shows distribution of tobacco users with respect to education. It was observed that percentage of tobacco users decreased with increase in level of education and the difference was statistically significant (χ2 = 54.56; P < 0.0001). Further observation revealed that type of tobacco use differed with sex and education but not with age. It was seen that use of smokeless tobacco was more common in less educated (75.47%) and in females (28%), whereas smoking was common among graduate males (51.1%).
Table 2: Distribution of tobacco use with respect to education


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As seen in [Figure 1], peer pressure turned out to be the major cause (159 (80.3%)) for starting the use of tobacco, followed by influence of family members (22 (11.2%)). Few people also reported staying away from family (9 (4.5%)) and to release stress (8 (4%)) as the cause of starting tobacco use.
Figure 1: Causes for initiating tobacco use

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Ill effects of passive smoking were known to 297 (69.7%) members of the population. Nearly three-forth, 304 (71.36%), of the participants were aware about ban on smoking in public places.


  Discussion Top


Tobacco smoking and smokeless tobacco use is widely prevalent in all countries and is contributing substantially to the burden of NCDS. As South Asia is major producer and net exporter of tobacco, various cultural practices prevail in this region which may indirectly include use of tobacco, e.g. offering hookah or paan to the guests. The epidemic of tobacco use is shifting from developed to developing countries, including India, where increased use is expected to result in a large disease burden in the future. It is estimated that among all the people who smoke worldwide, 16% live in India. Due to severity of this problem and its wide impact on health as well as economy of population at large, many researchers have studied different aspects of this problem.

In the traditional Indian system, the acceptance of lifestyle indicators such as tobacco use and alcohol consumption varies between socioeconomic groups and between genders. [5],[6] WHO report of year 2008 reveals that except in Nepal, male smoking rates are much higher than smoking rates in females. [7] Similar findings are reported by Jha et al. in a nationally representable sample of 1.1 million homes. [8] Result from our study supports the above findings. On the other hand, Sinha et al. have expressed concern over the decreasing difference in male and female tobacco users in the country. [9] The significant difference observed in our study population may be attributed to the rural background of our study population.

Evidence of a trend toward increasing use of tobacco in youth is reported in several studies. [10],[11] Man et al. reported that since 1991 adolescent tobacco use rates have increased while adult use has steadily decreased. [12] Reddy has expressed that changes in the prevalence of tobacco use in adolescents are important to monitor, since increased use by young people might be a precursor to increased rates in the population. [13] Proportion of tobacco use increased constantly with increasing age groups and a peak of 71.8% was observed among 55-64 year old respondents by Neufeld. [14] Results from our study population confirm this observation. We observed an increase in percentage of tobacco users till the age of 50, and a slight decrease thereafter both in males and females. Similar observation was done by Jha et al. [8] in males; however, they have reported a steady low prevalence in females. The increased use among females of our population is a cause of concern.

Impact of education on use of tobacco is reported by several studies. [10],[11],[14],[15] Our findings are not different from the studies with more than half of illiterate population using tobacco in some or the other form as compared to only 25.5% of graduates doing so. However, very few studies have shown the effect of education with respect to type of tobacco use. It was observed that tobacco chewing was more common in less educated, whereas smoking was more common among graduates.

The difference in use of type of tobacco was also observed with respect to sex in our study population. While tobacco chewing was most common in males, mishri was most common type of tobacco used by females. In countries of South Asia particularly India, traditional values do not favor smoking by the young or females, but there is no such taboo against smokeless tobacco. This may be the reason for mishri being more popular in females of our study population. Marchant has underlined the fact that there could be more important factors other than smoking that are associated with risk of oral cancer. [15] High prevalence of use of smokeless tobacco in our study population is thus a cause of concern.

Peer pressure was reported as the main inducing factor for tobacco use by a few studies. [16] Our findings are in accordance with these studies. Some researchers are of the opinion that use of tobacco by parents is likely to influence adolescents. [17],[18] However, Singh and Gupta [19] have observed that the prevalence of tobacco use in adolescent was low in school children in Jaipur district despite a moderately high prevalence of tobacco use among their family members Awareness of ill effects of tobacco use was significantly low 297 (69.7%) in our study, as compared to more than 90% in other studies. Lower awareness of ill effects of tobacco use in our study population belonging to rural area is a cause for concern.


  Conclusion Top


Large sections of some population subgroups are obsessed with tobacco and continuing, despite laws to tell the users of its lethal consequences. Our study points out that in spite of various efforts to increase awareness about hazards of tobacco, use of tobacco still prevails in less educated, rural population of India. Percentage of female tobacco users was found to be on higher side in this population as compared to other studies. At the same time, awareness of the ill effects of tobacco is low. Thus, effective measures are needed to address the uneducated female population of rural India, in order to decrease the use of tobacco significantly.

 
  References Top

1.WHO report on global tobacco epidemic 2011. Warning about the dangers of tobacco. Geneva: WHO; 2011.  Back to cited text no. 1
    
2.Thakur JS, Garg R, Narrain JP, Menabde N. Tobacco use: Major risk factors for non communicable disease in South East Asia region. Indian J Public Health 2011;55:155-60.  Back to cited text no. 2
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3.Kyaing NN, Islam MA, Sinha DN, Rinchen S. Social, economic and legal dimensions of tobacco and its control in South-East Asia region. Indian J Public Health 2011;55:161-8.  Back to cited text no. 3
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4.Gupta PC, Ray CS, Sinha DN, Singh PK. Smokeless tobacco:A major public health problem in SEA region: A review. Indian J Public Health 2011;55:199-209.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.Rani M, Bonu S, Jha P, Nguyen SN, Jamjoum L. Tobacco use in India: Prevalence and predictors of smoking and chewing in a nationally cross sectional household survey. Tob Control 2003;12:e4.   Back to cited text no. 5
    
6.Narayan KM, Chadha SL, Hanson RL, Tandon R, Shekhawat S, Fernandes RJ, et al. Prevalence and patterns of smoking in Delhi: Cross sectional study. BMJ 1996;312:1576-9.  Back to cited text no. 6
    
7.WHO report on tobacco in South East Asia-2008. The world bank, South Asia human development, health, nutrition and population. Available from: http://siteresources.worldbank.org/INTETC/Resources/TobaccoinSARfinalOct14.pdf [Last accessed on 2012 Nov 25].  Back to cited text no. 7
    
8.Jha P, Jacob B, Gajalakshmi V, Gupta PC, Dhingra N, Kumar R, et al. A nationaly representative case control study of smoking and death in India. N Engl J Med 2008;358:1137-47.  Back to cited text no. 8
    
9.Sinha DN, Gupta PC, Gangadharan P. Tobacco use among students and school personnel in India. Asian Pac J Cancer Prev 2007;8:417-21.  Back to cited text no. 9
    
10.Dobe M, Sinha DN, Rehman K. Smokeless tobacco use and its implications in WHO South East Asia region. Indian J Public Health 2006;50:70-5.  Back to cited text no. 10
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11.Makwana NR, Shah VR, Yadav S. A study on prevalence of smoking and tobacco chewing among adolescents in rural areas of Jamnagar dist-Gujrat. J Med Sci Res 2007;1:47-9.   Back to cited text no. 11
    
12.Sussman S. Effects of thirty-four adolescents tobacco use cessation and preventive trials on regular users of tobacco products. Drug Alcohol Depend1 999;4:1469-503.  Back to cited text no. 12
    
13.Reddy KS, Perry CL, Stigler MH, Arora M. Differences in tobacco use among young people in urban India by sex, socioeconomic status, age, and school grade: Assessment of baseline survey data. Lancet 2006;367:589-94.  Back to cited text no. 13
    
14.Neufeld KJ, Peters DH, Rani M, Bonu S, Brooner RK. Regular use of alcohol and tobacco in India and its association with age, sex and poverty. Drug Alcohol Depend 2005;77:283-91.  Back to cited text no. 14
    
15.Marchant A, Husain SS, Hosain M, Fikree FF, Pitiphat W, Siddiqui AR, et al. Paan without tobacco:An independent risk factor for oral cancer. Indian J Cancer 2000;86:128-31.  Back to cited text no. 15
    
16.Dongre A, Deshmukh P, Murali N, Garg B. Tobacco consumption among adolescents in rural Wardha: Where and how tobacco control should focus its attention. Indian J Cancer 2008;45:100-6.  Back to cited text no. 16
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17.Vaidya SG, Vaidya NS, Naik UD. Epidemiology of tobacco habits in Goa, India. Control of tobacco related cancers and other disease. Proceedings of international symposium, TIFR Bombay,1990. Bombay: Oxford University Press; 1992. p. 315-22.  Back to cited text no. 17
    
18.Ravishankar TL, Nagarjappa R. Factors attributing to initiation of tobacco use in adolescent students of Moradabad, (U.P) India. Indian J Dent Res 2009;20:346-9.  Back to cited text no. 18
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19.Singh V, Gupta R. Prevalence of tobacco use and awareness of risks among school children in Jaipur. J Assoc Physicians India 2006;54:609-11.  Back to cited text no. 19
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2]


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