Tobacco consumption and its association with various sociodemographic factors among females (15-49 years) residing in an urban slum of Pune, Maharashtra
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/0975-2870.169946
Context: Tobacco consumption among females is on rise and is increasing at an alarming rate. This epidemic among the females is emerging as an important public health problem especially in slums. Aim: Study was conducted to find out association between sociodemographic factors and tobacco consumption. Settings and Design: Community-based cross-sectional study was carried out among females (15-49 years) in an urban slum of Pune during February 12 to April 13. Materials and Methods: Sampling frame was prepared from records of urban health center. Required sample size was selected by simple random method. Data collected using pretested validated structured questionnaire after obtaining informed consent. Statistical Analysis: Statistical analysis was performed using SPSS 20, and Chi-square test was used for determining association. Results: Of 305 females studied, 31.5% of them were currently consuming tobacco. Most common form of tobacco consumption was smokeless that is, Mishri application 55.2%. About 64% females started using tobacco before 20 years of age. Most of them (32%) consuming tobacco for increasing concentration at work. Tobacco consumption was found to be significantly more common among ever-married and Muslim females. Lack of will power and ignorance about the harmful effects of tobacco were major hindrances (51%) for quitting tobacco Conclusion: Tobacco consumption was found to be prevalent in almost one third of females (15-49 years) residing in an urban slum of Pune. Most of them used smokeless tobacco, mainly Mishri. Tobacco consumption was directly associated with age, marital status and religion. Keywords: Females, Pune, tobacco consumption, urban slum
Tobacco use is the leading cause of preventable deaths. Its use kills up to half of those who consume it because of presence of more than 4000 harmful chemicals. [1] Worldwide, tobacco usage is responsible for 6% of female and 12% of male deaths respectively amounting to about five million deaths annually. [2]],[[3] By 2020, tobacco related deaths are projected to increase to 10% of all deaths. [4] Consumption of tobacco among females is in alarming state all over the world. This is causing damage to their physical, mental and social health as well as their economic progress. Presently, 12% of the world's women population consume tobacco and will continue to rise to 20% by 2025. [1] In India, approximately one million people die every year due to tobacco related diseases and will account for 13% of total deaths by 2020. [5]],[[6] About 20% of female use the smokeless form of tobacco while 10% smokes. [7] In Maharashtra, tobacco use is emerging as an important public health problem and about 19% of adult females are addicted to tobacco. [8] This rising trend is a cause of worry especially in India. Tobacco causes a broad spectrum of ill effects and diseases such as oral cancer, adverse reproductive outcomes and premature death. [3] Very less is known about tobacco consumption among females residing in slum area and hence, study was carried out to know the prevalence, pattern of tobacco consumption and its association with various sociodemographic factors.
A community-based cross-sectional study was conducted at an urban slum, Wanowrie in Pune district among all females in the age group of 15-49 years who are permanent residents and willing to participate in the study during February 12 to April 13. Wanowrie is located approximately 10 km away from Pune and covers population of about 3500. For the purpose of sample size estimation, formula used was n = [Z 1−α/2 ] 2π (1-π)/d 2 . Precision of the estimate (d) is set at 5%. Prevalence was taken as 25.3% [8] and confidence level as 95% (i.e., α = 0.05). Minimum sample size for the population was estimated to be 304. Sampling frame was prepared from records of urban health center. Required sample size was selected by simple random method using random number table. For the purpose of study, participants were classified according to the highest educational standard up to which they had gone to school that is, Primary school (up to 5 th class), Middle school (up to 8 th class), high school (up to 10 th class) and above (11 th class onward). Illiterate were those who could not read and write with understanding any one language. Age was recorded as a continuous variable in completed years. Individuals with age 15 years and above as on 1 Jan 2012 were considered. Age was decided with the help of birth certificates/electoral voter ID card. Socioeconomic status (SES) was decided as per Kuppuswamy scale. [9] Current tobacco users were defined as those who had been consuming tobacco in any form either daily or occasionally. Former users were those who had been tobacco consumers in the past but had not consumed tobacco in any form in last 1-year. Never users of tobacco were those who had never consumed tobacco. Data were collected by making house to house visits and interviewing all the eligible subjects using pretested structured questionnaire. Verbal informed consent was taken from the females before interviewing them. In case of absence of selected study subject in the house in first visit, same house was visited two more times. Even then if study subject was not available, then next eligible subject was approached. This methodology was followed till completion of required number of study subjects. Data were analyzed using SPSS software (version 20.0, IBM corporation) and appropriate statistical tests were used after consulting statisticians.
A total of 305 females in the age group of 15-49 years were included in the study. Mean age of study population was 31.7 years. The demographic characteristics of study population are shown in [Table 1]. Most of them were Hindu (63.3%) and in the age group of 35-49 years (44.6%). Most of them were literate (94.4%). About 58.7% of females were from upper lower SES.
Of 305 study subjects, 96 (31.5%) were currently consuming tobacco while 199 (65.3%) never used it in any form. Ten (3.3%) of them were previous users [Figure 1].
Smokeless form of tobacco consumption was the predominant (93.7%) way among tobacco consumer. The most common smokeless tobacco practice was found to be Mishri application (55.2%) followed by quid use (20.8%). Smoking was prevalent in 4.2% of tobacco consumers mainly in the form of beedi. About 2.1% of current users consume tobacco in the form of Hookah [Figure 2].
About 64% of the current tobacco users started using tobacco before the age of 20 and about one fourth were in 20-29 years age [Table 2].
About 32% of users started consuming tobacco to concentrate at work/study. Peer pressure (25%) was the second most important reason for using tobacco. Some of them also started consumption of tobacco for relieving stress and for fun [Figure 3].
As can be seen from [Table 3], among those who consumed tobacco, maximum numbers of females (58.3%) were in the 35-49 years age group. Tobacco consumption increased as age increased. The association was found to be statistically significant (χ2 = 18.87, df = 2, P = 0.0000).
It has been also observed that, religion was statistically associated with consumption of tobacco (χ2 = 5.04, df = 2, P = 0.024). More number of Muslims (42.7%) consumed tobacco as compared to Hindu (33.9%) and Christian (2.9%). For the purpose of analysis, the study subjects were regrouped as illiterate and literate. About 53% of total illiterate consumed tobacco as compared to 31.3% of literate but no statistically significant association was observed. For ease of study, population was reclassified as ever-married and unmarried. Ever-married includes married, widow as well as divorcee. Out of total tobacco consumers, maximum (84.4%) were ever-married. Significant association was seen between these groups (χ2 = 21.21, df = 1, P = 0.000). Most of the tobacco consumers (65.62%) were from upper lower SES with no association with consumption of tobacco and SES (P = 0.053). Lack of will power and ignorance about the harmful effects of tobacco were major hindrances (51%) for quitting tobacco use followed by stress (20%). Also people around using tobacco (14%) including parents and craving for tobacco (14%) were important factors [Figure 4].
It was observed that, among 305 females studied, 31.5% females were found to be using tobacco. These findings were comparable with Global Adult Tobacco Survey (GATS) survey conducted in 2009-2010 in which prevalence of tobacco use (in some form or the other) among adults was noted as 35%. Study conducted in Maharashtra in 2003 showed prevalence of tobacco smoking and chewing among 15 years and above was 0.2% and 18% respectively in females. [10] Our study showed higher prevalence of tobacco consumption as compared to this study. The present study found that, Mishri was most commonly used followed by tobacco with lime (Quid). Similar findings were observed in study conducted by Jindal et al. in the Central and Western parts of India. [11] In Pune district, Maharashtra, almost no female smoked but 49% of females consumed smokeless tobacco; of which 39% used Mishri. [12] According to GATS report, Khaini or tobacco lime mixture (12%) was the most commonly used form of tobacco consumption in India. Tobacco smoking (4.2%) was higher than the results of the study conducted by Mehta et al. in Pune in which smoking prevalence was observed as 1%. [12] The study revealed association of tobacco use with age which was similar to study by Jindal et al. [11] Tobacco consumption in different age groups, as found in our study that is, 9.7% among 15-19 years old, 28.1% among 20-34 year olds, and 44.4% among 35-49 year olds, was higher than that reported in National Family Health Survey-3 that is, 3.5%, 9.1% and 18.3% in respective age groups. [13] More than half of females started tobacco consumption before the age of 20 years. This was comparable with the study conducted by Narain et al. which showed that about 80% of girl's ≤15 years initiated the habit of tobacco before the age of 11 years. [14] An average Indian woman was consuming at seventeen and half years of age. [7] Our study revealed that there was no association between tobacco use and education. This finding was inconsistent with study by Jindal et al. [10] and also with GATS survey. In this survey tobacco use decreased with increase in educational level. Present study revealed significant statistical association with religion similar to the study by Rani et al. which also showed that Muslim females were more likely to chew tobacco than Hindu females. [10] Marital status showed statistical association with consumption of tobacco which was similar to study by Rani et al. Ever-married females consumed tobacco more commonly than unmarried. [10] No significant association with SES was observed in our study, which was in contrast to study by Bhan et al. in which lower socioeconomic females used tobacco more frequently than upper class. [15]
This study brings out knowledge about pattern of tobacco consumption and associated factors with it among slum females. Prevalence of tobacco consumption among studied female population was 31.5%. Most of them consumed smokeless tobacco mainly Mishri. Most of the tobacco consumers have started consuming tobacco in their twenties. Increased age, Muslim religion and ever-married status were at disadvantage of consuming tobacco. Therefore increasing attention requires to be given toward these vulnerable groups. Health educational interventions in the form of role playing, drama, group discussions including involvement of media for creating awareness and involvement of local health volunteers, School teachers, Anganwadi workers and nongovernmental organizations will help in making these groups aware about harmful effects of tobacco and thereby help in reducing subsequent morbidity and mortality related to tobacco consumption among these slum females. The lack of significant associations of tobacco consumption with education and with SES, seen otherwise with tobacco consumption needs further large scale study to understand the relationship between them. Policymakers should consider all above factors for future planning of preventive and promotive measures for these vulnerable females for optimum utilization of scare health resources.
Being a cross-sectional study and self-reported format; this study has its inherent limitations. No definite information regarding some socio economic factors available on the basis of this study. It was not possible to draw a conclusion whether the factors and its association with tobacco consumption in the individuals were antecedent or consequences of tobacco consumption.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]
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