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ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 163-169

Knowledge and perception about health risks associated with tobacco habit – A survey


Department of Oral and Maxillofacial Pathology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India

Date of Submission02-Jul-2020
Date of Acceptance04-Jul-2020
Date of Web Publication15-Sep-2020

Correspondence Address:
Dr. L Casilda Sushanthi
Department of Oral and Maxillofacial Pathology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai - 600 077, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejgd.ejgd_248_20

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  Abstract 


Introduction: Nicotiana tabacum, a South American herb, is the main source of tobacco. The use of tobacco for medicinal purposes emerged in the 1400s, and later in 1800–1900, the presence of nicotine in tobacco was discovered, leading to tobacco abuse. Apart from tobacco use, manufacturing tobacco, packaging, and even disposal of cigarette butts and packages have an environmental effect. Tobacco is available in different types from manufactured cigarettes, hookahs, bidis, cigars, cheroots, and chewing tobacco. The main aim of the study was to assess the knowledge of health risks associated with tobacco habit in tobacco users. Materials and Methods: A descriptive cross-sectional survey was conducted among tobacco users visiting a private dental institution. A total of 100 participants were involved, and a questionnaire containing 21 closed-ended questions was prepared and distributed online using Google Survey Forms. The responses were collected, tabulated in excel, and statistically analyzed using SPSS. Chi-square test was done to assess the knowledge of the participants regarding the health risks of tobacco.Results: The majority of the participants smoked everyday for the past 3–10 years. Manufactured cigarettes were predominantly used among the 100 participants. The majority of the participants were aware that smoking causes lung and heart diseases in adults. Most of the participants were also aware of passive smoking. Conclusion: Immense programs regarding disposal of cigarette butts and awareness in young adults should be practiced to reduce the consumption of tobacco.

Keywords: Awareness, health hazards, tobacco, tobacco cessation


How to cite this article:
Sushanthi L C, Santhanam A, Sherlin HJ, Jayaraj G, Don KR. Knowledge and perception about health risks associated with tobacco habit – A survey. Eur J Gen Dent 2020;9:163-9

How to cite this URL:
Sushanthi L C, Santhanam A, Sherlin HJ, Jayaraj G, Don KR. Knowledge and perception about health risks associated with tobacco habit – A survey. Eur J Gen Dent [serial online] 2020 [cited 2020 Nov 24];9:163-9. Available from: https://www.ejgd.org/text.asp?2020/9/3/163/295092




  Introduction Top


Tobacco is a South American herb derived from Nicotiana tabacum whose leaves contain 2%–8% nicotine and serve as the source for both smoking and smokeless tobacco forming the basis of health hazards.[1] In 1492, Columbus discovered that Native Americans used tobacco for both its pleasurable effects and for treating diseases. Tobacco was also mixed with equal parts of slaked lime and was used as a toothpaste by Native Americans. Even in India today, tobacco powder is used to whiten the teeth and commercially sold as tobacco toothpaste. In the 1500s, the medicinal property of tobacco was more prevalent in America and Europe. Only in the 1600s, tobacco faced its criticism as a medicinal herb and ill effects of tobacco abuse were noted. Around 1828, nicotine was isolated from tobacco and its medicinal use started decreasing.

In the late twentieth century, tobacco abuse emerged globally affecting all age groups and increasing the death rates.[1]

The main component of tobacco, nicotine, causes individuals to become addicted. Nicotine in small amounts is lethal by nature. Inhalation of nicotine released from tobacco smoke enters the body and affects all the organs. Nicotine in small amounts simulates the brain and central nervous system (CNS) and larger amounts depresses the brain and CNS. Nicotine vapors also increase the blood pressure and heart rate in smokers.[1] Tobacco use contributes to the majority of oral, larynx, and lung cancers. A 2010 analysis conducted in the US stated that around 9000 premature deaths were caused by tobacco usage in young people and adults.[2]

Tobacco causes abnormal DNA methylation in adults leading to cancer.[3] Oral squamous cell carcinoma (OSCC) which accounts for 90% of cancers in the oral cavity ranks 8th position worldwide in deaths related to cancers. This trend is more appreciated in low-income or developing countries than developed countries. OSCC is regulated by many factors such as age, gender, race, and tobacco habits, among which tobacco is the main contributing factor.[4]

The World Health Organization stated that “The tobacco epidemic is one of the biggest public health threats the world has ever faced, killing more than 8 million people a year around the world. More than 7 million of those deaths are a result of direct tobacco use, while around 1.2 million are the result of nonsmokers being exposed to secondhand smoke.” The mortality rate of tobacco use is calculated to exceed 10 million by 2030. Tobacco when burned contains 4000 chemical compounds out of which 69 are carcinogenic in nature.[5]

Smoked tobacco types include cigars, pipes, bidis, kreteks, waterpipes, and cheroots. Smokeless tobacco products include chewing tobacco, moist snuff, dry snuff, betel quid (with tobacco), gutkha, toombak, and dissolvable tobacco. The common misconception that smokeless tobacco is less hazardous than smoked tobacco leads to abuse of smokeless tobacco, while both have the same carcinogenic effect.[6]

Tobacco abuse is hazardous to the world as a whole. Tobacco smoke affects humans of all age groups irrespective of race and leads to death. Although numerous literatures in the past two decades enumerate the ill effects of tobacco, the manufacturing and the consumption of smoked and smokeless tobacco products have only gradually increased. The main purpose of this present study was to assess the mindset and knowledge of individuals with tobacco habits regarding the health hazards associated with tobacco usage.


  Materials and Methods Top


Study design

A cross-sectional study was conducted through an online/manual survey from October 2019 to January 2020 among tobacco users visiting a private dental institution, Chennai.

Study subjects

A simple random sampling was used to select the study participants. The 100 participants in the study belong to various age groups with tobacco habits.

Inclusion criteria

Tobacco users with current tobacco habits with no history of quitting were included in the study.

Ethical considerations

Returning the filled questionnaire was considered as implicit consent as a part of the survey. Ethical approval for the study was obtained from the Institutional Review Board, Saveetha Dental College and Hospitals, Chennai.

Study methods

A questionnaire of 21 closed-ended questions was prepared and distributed online by Google Forms. The questionnaire was also prepared in regional language to help individuals with English as no second language. The collected data were checked regularly for clarity, consistency, and accuracy. Demographic details were also included in the questionnaire.

Statistical analysis

The data collected were tabulated in Microsoft Excel 2016 and exported to SPSS software (IBM® SPSS® Statistics version 24, Chicago, USA). Descriptive statistics to summarize qualitative data in percentages were calculated. Chi-square test was done to associate the knowledge of smokers about health hazards of tobacco use. The confidence level was 95%, with a statistical significance of P < 0.05. The results were presented in the form of graphs and tables.


  Results Top


Out of 100 participants, 92% were males and 8% were females. Fifty-two percent of the participants were in the age group of 26–35 years, 25% belonged to the age group of 18–25 years, 13% belonged to the age group of 36–45 years, 8% belonged to the age group of 46–55 years, and 2% belonged to the age group of above 55 years [Table 1].
Table 1: Percentage distribution on knowledge and perception about health risks associated with tobacco habit

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Eight seven percent of the participants smoked on a daily basis. Forty-eight participants belonging to the age group of 26–35 years smoked <5 cigarettes per day with P = 0.098 which is statistically not significant [Figure 1]. Fifty-two percent of the participants smoked <5 cigarettes per day, 24% smoked 5–10 cigarettes per day, 17% smoked more than 10 cigarettes per day, and 7% smoked 1–2 cigarettes per day.
Figure 1: Bar chart depicting the association between the age groups and everyday tobacco use. Forty-eight of the participants belonging to the age group of 26–35 years smoked <5 cigarettes per day with P = 0.098, which is not statistically significant

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Twenty-eight participants belonging to the age group of 26–35 years smoked <5 cigarettes per day with P = 0.085 which is statistically not significant [Figure 2]. Forty-two percent of the participants have the habit for the past 1–5 years, 42% have the habit for the past 6–10 years, 13% smoke for the past 11–15 years, and 3% smoke for more than 15 years. Ninety-six percent of the participants use manufactured cigarettes.
Figure 2: Bar chart depicting the association between the age groups and number of cigarettes smoked. Twenty-eight participants belonging to the age group of 26–35 years smoked <5 cigarettes per day with P = 0.085, which is not statistically significant

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Twenty-six percent of the participants disagree that long-term users can reduce the risk of cancer by quitting smoking. Seventeen participants belonging to the age group of 26–35 years disagree that long-term users can reduce the risk of cancer by quitting smoking with P = 0.485 which is statistically not significant [Figure 3]. Seventy-six percent of the participants were aware that smoking causes both lung and heart diseases. Seventy-eight percent of the participants were aware that smoking affects a nonsmoking person nearby. Forty-one participants belonging to the age group of 26–35 years were aware that smoking affects a nonsmoking person nearby with P = 0.091 which is statistically not significant [Figure 4]. Fifty-four percent of the participants were aware of smokeless tobacco.
Figure 3: Bar chart depicting the association between the age groups and reduced risks of cancer in long-term users after quitting. Seventeen participants belonging to the age group of 26–35 years disagree that long-term users can reduce the risk of cancer by quitting smoking with P = 0.485, which is not statistically significant

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Figure 4: Bar chart depicting the association between the age groups and passive smoking awareness. Forty-one participants belonging to the age group of 26–35 years were aware that smoking affects a nonsmoking person nearby with P = 0.091, which is not statistically significant

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Fifty percent of the participants believe that smokeless tobacco is less lethal than cigarette smoking. Twenty-two participants belonging to the age group of 26–35 years disagree that smokeless tobacco is less harmful and lethal than cigarette smoking with P = 0.384 which is statistically not significant [Figure 5]. Eighty-eight percent of the participants agree that smoking makes them feel better.
Figure 5: Bar chart depicting the association between the age groups and awareness of lethal effects of smokeless tobacco. Twenty-two participants belonging to the age group of 26–35 years disagree that smokeless tobacco is less harmful and lethal than cigarette smoking with P = 0.0384, which is not statistically significant

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Fifty-nine percent of the participants were aware that tobacco contains 4000 chemical compounds in which 69 are carcinogenic agents. Forty-seven percent of the participants disagree that nicotine is more addictive and lethal than heroin and cocaine. Twenty-one participants belonging to the age group of 26–35 years disagree that nicotine is more addictive and lethal than heroin and cocaine with P = 0.223 which is statistically not significant [Figure 6]. Forty-two percent of the participants have tried to quit smoking in the past 12 months. Twenty-six participants have tried to quit smoking in the past 12 months with P = 0.021 which is statistically significant [Figure 7]. Thirty-seven percent of the participants have visited health-care providers to quit smoking. Thirteen participants belonging to the age group of 26–35 years have visited health-care providers to quit smoking with P = 0.082 which is statistically not significant [Figure 8]. Ninety percent of the participants were aware of the information about the dangers of smoking cigarettes. They were also aware of the advertisements in newspapers or television that encourages smokers to quit smoking. Ninety-five percent of the participants agree that they notice the health warnings on cigarette packages. Forty-five participants belonging to the age group of 26–35 years agree that they notice the health warnings on cigarette packages with P = 0.782 which is statistically not significant [Figure 9]. Eight-three percent of the participants ignore the health warnings on cigarette packages. Seventy-six percent of the participants do not encourage their friends to smoke. Fifty-one percent of the participants agreed that they would try to quit smoking if help was offered. Thirty-one participants belonging to the age group of 26–35 years agreed that they would try to quit smoking if help was offered with P = 0.086 which is statistically not significant [Figure 10].
Figure 6: Bar chart depicting the association between the age groups and nicotine property. Twenty-one participants belonging to the age group of 26–35 years disagree that nicotine is more addictive and lethal than heroin and cocaine with P = 0.223, which is not statistically significant

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Figure 7: Bar chart depicting the association between the age groups and efforts to quit smoking. Twenty-six participants have tried to quit smoking in the past 12 months with P = 0.021, which is statistically significant

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Figure 8: Bar chart depicting the association between the age groups and efforts to quit smoking by visiting a health-care provider. Thirteen participants belonging to the age group 26–35 years have visited health-care providers to quit smoking with P = 0.082, which is not statistically significant

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Figure 9: Bar chart depicting the association between the age groups and noticing the health warnings on cigarette packages. Forty-five participants belonging to the age group of 26–35 years agree that they notice the health warnings on cigarette packages with P = 0.782, which is not statistically significant

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Figure 10: Bar chart depicting the association between the age groups and response of participants to quit smoking if help was offered. Thirty-one participants belonging to the age group of 26–35 years agreed that they would try to quit smoking if help was offered with P = 0.086, which is not statistically significant

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  Discussion Top


Tobacco derived from N. tabacum is a South American herb primarily used for its medicinal properties in the 1400s. In later centuries, health hazards of tobacco use were identified after the discovery of nicotine content in tobacco. When cigarettes are lit, the tobacco smoke emitted contains nicotine that enters the human body easily and affects the organs. Longer duration of exposure to nicotine causes neurotoxicity and blood toxicity and alters the structural architecture of the brain. Tobacco is the main contributing factor for cancer in the oral cavity.

In the present study, the majority of the participants, i.e., 92%, were males. This finding is in accordance with the literature by Rani et al. who stated that the rate of prevalence of tobacco usage was 51.3% for men and 10.3% for women.[7] The difference of tobacco consumption in gender could be because of the social and cultural practices in our country, India, and mostly, women belonging to middle-class backgrounds are not exposed to tobacco products in India. The majority of the participants belonged to the age group of 26–35 years, followed by the age group of 18–25 years. Eighty-seven percent of the participants smoke everyday, predominantly smoking 1–5 cigarettes per day. Everyday smoking increases the intake of carcinogens by the smoker, simultaneously affecting the environment and individuals by passive smoking. This finding is in accordance with the literature by Schane et al., who stated that young adult smokers consuming <5 cigarettes everyday have considerably increased in the past decade.[8] Apart from everyday smoking, it was also found in our study that the majority of the smokers were smoking for the past 3–10 years. Chronic exposure to tobacco smoke increases the toxic levels in the body, simultaneously polluting the air and affecting other individuals by passive smoking.

There are numerous variants of tobacco available in the market, and it was found in our study that manufactured cigarettes were predominantly used by smokers. Rationale to invent machines to manufacture cigarette sticks was an outcome of tuberculosis occurrence due to spitting of smokeless tobacco. Machines to manufacture cigarettes were patented in the 1880s by James Bonsack. Ever since, the use of manufactured cigarettes rather than smokeless tobacco evolved.[9] The downside of using manufactured cigarettes apart from tobacco smoke is disposal of the cigarette sticks postconsumption. Cigarette butts constitute about 30% of total litter globally. The most common method of cigarette butt disposal is nearby water bodies or empty grounds. Nicotine, heavy metals, and polycyclic aromatic hydrocarbons found in cigarette butts leak into the water and soil harming the environment and aquatic organisms. Freshwater species are known to be more affected by these chemical agents. The paper and other materials used for manufacturing cigarette packages also sum up for trillions of unwanted solid waste and potentially affecting the environment.[10]

In our study, it was found that the majority of the participants were aware that quitting smoking in long-term smokers cannot reduce cancer risk. From the initial days of smoking, the tobacco smoke enters the body and affects the organs. Individuals who quit smoking at younger ages have higher rates of improving their health conditions. Individuals with a history of cancer are susceptible to cancer recurrence and long-term side effects. Damage caused by smoking is irreversible, but quitting smoking alters the health, reduces cancer risk, and improves the quality of life by 10 years.[11] Misconception about immediately recovering health after quitting smoking should be addressed. The striking feature of our study is that the majority of the participants were aware of passive smoking. However, not many participants were aware of ill effects of smokeless tobacco. Literatures provide evidence that smokeless tobacco has the same carcinogenic effects as smoking cigarettes. Aboaziza and Eissenberg state that consumption of Waterpipe tobacco smoking is gradually increasing globally due to the lack of knowledge of nicotine content in tobacco smoke. This abuse of smokeless tobacco increases the intake of tobacco vapors in smokers.[12]

Forty-seven percent of the participants disagree that nicotine in tobacco is more addictive than cocaine. This finding is in accordance with the literature by Roh who states that nicotine does not induce intoxication like caffeine or other drugs and cannot be addictive. Smokers with withdrawal symptoms tend to resume smoking due to changes in the structural patterns in the brain and not due to nicotine.[13] Despite the awareness about tobacco causing ill effects to self and others, only 42% of the participants in the present study have tried to quit smoking and only 17% of the participants have visited a health-care provider to quit smoking in the past 12 months. Predominantly 95% of the participants notice the health warnings on the cigarette packages, and majority of them ignore the warnings. Emily T Hebert states that social media have an impact on delivering knowledge to young adults and high school children and might become an essential tool in reaching out to more population.[13]

The authors acknowledge the presence of study limitations such as lesser sample size. The participants included were those with tobacco habit only, and knowledge regarding tobacco health hazards should also be evaluated in nonsmokers.


  Conclusion Top


The present study provides an insight that even though the majority of the participants were aware of health risks associated with tobacco use, they chose to continue the tobacco habit. The negligence and ignorance is due to environmental issues surrounding the individual where smoking has become a common habit. Decreasing the rates of cigarette manufacturing and increasing the counseling of the vendors to limit the supply of cigarette packages to young people could be a revolutionary start in making this world tobacco free.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Ma Y, Li MD. Establishment of a strong link between smoking and cancer pathogenesis through DNA methylation analysis. Sci Rep 2017;7:1811.  Back to cited text no. 3
    
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Jiang X, Wu J, Wang J, Huang R. Tobacco and oral squamous cell carcinoma: A review of carcinogenic pathways. Tob Induc Dis 2019;17:29.  Back to cited text no. 4
    
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O'Connor RJ. Non-cigarette tobacco products: What have we learnt and where are we headed? Tob Control 2012;21:181-90.  Back to cited text no. 6
    
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Rani M, Bonu S, Jha P, Nguyen SN, Jamjoum L. Tobacco use in India: Prevalence and predictors of smoking and chewing in a national cross sectional household survey. Tob Control 2003;12:e4.  Back to cited text no. 7
    
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Schane RE, Ling PM, Glantz SA. Health effects of light and intermittent smoking: A review. Circulation 2010;121:1518-22.  Back to cited text no. 8
    
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IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, World Health Organization, International Agency for Research on Cancer. Tobacco Smoke and Involuntary Smoking. IARC; 2004.  Back to cited text no. 9
    
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Slaughter E, Gersberg RM, Watanabe K, Rudolph J, Stransky C, Novotny TE. Toxicity of cigarette butts, and their chemical components, to marine and freshwater fish. Tob Control 2011;20 Suppl 1:i25-9.  Back to cited text no. 10
    
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Liu F. Quit attempts and intention to quit cigarette smoking among Medicaid recipients in the USA. Public Health 2010;124:553-8.  Back to cited text no. 11
    
12.
Aboaziza E, Eissenberg T. Waterpipe tobacco smoking: What is the evidence that it supports nicotine/tobacco dependence? Tob Control 2015;24 Suppl 1:i44-53.  Back to cited text no. 12
    
13.
Roh S. Scientific evidence for the addictiveness of tobacco and smoking cessation in tobacco litigation. J Prev Med Public Health 2018;51:1-5.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]
 
 
    Tables

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