Tobacco use and nicotine dependence among the adult males of different socioeconomic groups within a medical college campus in Ammapettai, Kancheepuram district of South India
Keywords:smoking tobacco, smokeless tobacco, nicotine dependence, socioeconomic groups, health disparity
AbstractBACKGROUND: India is becoming one of the most tobacco consuming countries with the expected number tobacco-related deaths equaling to more than 1.5 million annually by 2020. As strong socioeconomic differences exist in the pattern and type of tobacco consumption across large number of communities and through varied cultures across the country, the objective of this study is to understand if there is any difference by socioeconomic status (SES) in nicotine dependence level and other characteristics related to tobacco quitting in tobacco users employed in a medical college campus. METHODS: Cross-sectional survey was conducted with a pretested questionnaire among 150 current tobacco users from different departments within the campus. The level nicotine dependence was diagnosed using the Fagerstrom's nicotine dependence test. Kuppuswamys socioeconomic classification (2012) was used to group them by socioeconomic strata. Data was also collected on pattern and type of tobacco use, nicotine addiction, and attitude towards quitting tobacco use and tobacco control policies. Data collected was analysed using SPSS 21 and Epi-info 7 with the use of statistical tests of independence as well as binary logistic regression analysis. RESULTS: Nicotine dependence was higher in the lower SES groups than higher SES groups. Cigarette smoking prevailed among higher SES groups whereas bidi smoking was higher in lower SES groups. Smokeless tobacco was predominantly used in the lower SES groups. Awareness about the harmful effects of tobacco use was poorer in the low SES groups while the willingness to quit and the number of quit attempts did not differ by SES. More affluent tobacco users reported earlier initiation of tobacco use than those from lower SES groups. CONCLUSION: SES groups of tobacco users differ in type and pattern of tobacco use, dependence, age of initiation and awareness but not in intention and efforts to quit tobacco.
Agrawal, S., Karan, A., Selvaraj, S., Bhan, N., Subramanian, S. V., & Millett, C. (2013). Socio-economic patterning of tobacco use in Indian states. Int J Tuberc Lung Dis, 17(8), 1110-1117. doi: 10.5588/ijtld.12.0916
Bhawna, G. (2013). Burden of smoked and smokeless tobacco consumption in India - results from the Global adult Tobacco Survey India (GATS-India)- 2009-201. Asian Pac J Cancer Prev, 14(5), 3323-3329.
Businelle, M. S., Kendzor, D. E., Reitzel, L. R., Costello, T. J., Cofta-Woerpel, L., Li, Y., . . . Wetter, D. W. (2010). Mechanisms linking socioeconomic status to smoking cessation: a structural equation modeling approach. Health Psychol, 29(3), 262-273. doi: 10.1037/a0019285
Clayton, R. R., Flaherty, B. P., & Alexander, L. A. (2007). Conceptual and methodological issues for research on tobacco-related health disparities. Addiction, 102, 1-4. doi: 10.1111/j.1360-0443.2007.01951.x
Denney, J. T., Rogers, R. G., Hummer, R. A., & Pampel, F. C. (2010). Education inequality in mortality: The age and gender specific mediating effects of cigarette smoking. Soc Sci Res, 39(4), 662-673. doi: 10.1016/j.ssresearch.2010.02.007 [doi]
Fagan, P., Moolchan, E. T., Lawrence, D., Fernander, A., & Ponder, P. K. (2007). Identifying health disparities across the tobacco continuum. Addiction, 102, 5-29. doi: 10.1111/j.1360-0443.2007.01952.x
Fagerstrom, K. O. (1978). Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addict Behav, 3(3-4), 235-241.
Fagerstrom, K. O., & Schneider, N. G. (1989). Measuring nicotine dependence: a review of the Fagerstrom Tolerance Questionnaire. J Behav Med, 12(2), 159-182.
Germain, D., Durkin, S., Scollo, M., & Wakefield, M. (2012). The long-term decline of adult tobacco use in Victoria: changes in smoking initiation and quitting over a quarter of a century of tobacco control. Aust N Z J Public Health, 36(1), 17-23. doi: 10.1111/j.1753-6405.2011.00805.x
Gilman, S. E., Abrams, D. B., & Buka, S. L. (2003). Socioeconomic status over the life course and stages of cigarette use: initiation, regular use, and cessation. J Epidemiol Community Health, 57(10), 802-808.
Gupta, V., Yadav, K., & Anand, K. (2010). Patterns of tobacco use across rural, urban, and urban-slum populations in a north Indian community. Indian J Community Med, 35(2), 245-251. doi: 10.4103/0970-0218.66877
Hiscock, R., Bauld, L., Amos, A., Fidler, J. A., & Munafo, M. (2012). Socioeconomic status and smoking: a review. Ann N Y Acad Sci, 1248, 107-123. doi: 10.1111/j.1749-6632.2011.06202.x
Hiscock, R., Bauld, L., Amos, A., & Platt, S. (2012). Smoking and socioeconomic status in England: the rise of the never smoker and the disadvantaged smoker. J Public Health (Oxf), 34(3), 390-396. doi: 10.1093/pubmed/fds012
International Institute for Population Sciences. (2007). India National Family Health Survey (NFHS-3), 2005-06 (Vol. 1): International Institute for Population Sciences.
Irvin Vidrine, J., Reitzel, L. R., & Wetter, D. W. (2009). The role of tobacco in cancer health disparities. Curr Oncol Rep, 11(6), 475-481.
Jayakrishnan, R., Mathew, A., Lekshmi, K., Sebastian, P., Finne, P., & Uutela, A. (2012). Assessment of nicotine dependence among smokers in a selected rural population in Kerala, India. Asian Pac J Cancer Prev, 13(6), 2663-2667.
Lund, K. E., & Lund, M. (2005). Smoking and social inequality in Norway 1998-2000 (in Norwegian). Tidsskr Nor Laegeforen, 125(5), 560-563. doi: 1152212 [pii]
Moolchan, E. T., Fagan, P., Fernander, A. F., Velicer, W. F., Hayward, M. D., King, G., & Clayton, R. R. (2007). Addressing tobacco-related health disparities. Addiction, 102, 30-42. doi: 10.1111/j.1360-0443.2007.01953.x
Murray, C. J., & Lopez, A. D. (1997). Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet, 349(9064), 1498-1504. doi: 10.1016/s0140-6736(96)07492-2
Pampel, F. C., & Rogers, R. G. (2004). Socioeconomic status, smoking, and health: a test of competing theories of cumulative advantage. J Health Soc Behav, 45(3), 306-321.
Patro, B. K., Jeyashree, K., & Gupta, P. K. (2012). Kuppuswamy's socioeconomic status scale 2010-the need for periodic revision. Indian J Pediatr, 79(3), 395-396. doi: 10.1007/s12098-011-0517-7
Preeti, S., & Raut, D. (2012). Prevalence and Pattern of Tobacco Consumption in India. International Research Journal of Social Sciences, 1(4), 36- 43.
Ramakrishna, G. S., Sankara Sarma, P., & Thankappan, K. R. (2005). Tobacco use among medical students in Orissa. Natl Med J India, 18(6), 285-289.
Reid, J. L., Hammond, D., Boudreau, C., Fong, G. T., Siahpush, M., & Collaboration, I. T. C. (2010). Socioeconomic disparities in quit intentions, quit attempts, and smoking abstinence among smokers in four western countries: findings from the International Tobacco Control Four Country Survey. Nicotine Tob Res, 12 Suppl, S20-33. doi: 10.1093/ntr/ntq051
Siahpush, M., McNeill, A., Borland, R., & Fong, G. T. (2006). Socioeconomic variations in nicotine dependence, self-efficacy, and intention to quit across four countries: findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control, 15 Suppl 3, iii71-75. doi: 10.1136/tc.2004.008763
Viswanath, K., Breen, N., Meissner, H., Moser, R. P., Hesse, B., Steele, W. R., & Rakowski, W. (2006). Cancer knowledge and disparities in the information age. J Health Commun, 11 Suppl 1, 1-17. doi: 10.1080/10810730600977517
Wetter, D. W., Cofta-Gunn, L., Irvin, J. E., Fouladi, R. T., Wright, K., Daza, P., . . . Gritz, E. R. (2005). What accounts for the association of education and smoking cessation? Prev Med, 40(4), 452-460. doi: 10.1016/j.ypmed.2004.07.001
World Health Organization. (2011). WHO report on the global tobacco epidemic, 2011: Warning about the dangers of tobacco. Geneva: World Health Organization.
Yong, H. H., Siahpush, M., Borland, R., Li, L., O'Connor, R. J., Yang, J., . . . Yuan, J. (2013). Urban chinese smokers from lower socioeconomic backgrounds face more barriers to quitting: results from the international tobacco control-China survey. Nicotine Tob Res, 15(6), 1044-1051. doi: 10.1093/ntr/nts234