|Year : 2016 | Volume
| Issue : 9 | Page : 226-231
|Urban and rural disparity in tobacco use and knowledge about oral cancer among adolescents: An epidemiological survey on 12 and 15-year school going students
Rajesh Sabnis, Kamtaram Sahu, Deepak Thakur, Sanidhya Surana, Heena Mazhar, Soumy Pandey
Department of Oral and Maxillofacial Surgery, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India
|Date of Submission||30-Mar-2016|
|Date of Acceptance||08-Dec-2016|
|Date of Web Publication||30-Dec-2016|
Department of Oral and Maxillofacial Surgery, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aims and Objectives: To assess and compare the tobacco use prevalence; to understand and compare attitudes and knowledge related to tobacco use and its health impact among urban and rural students; and to assess urban and rural disparity in the use of tobacco among 12 and 15-year-old adolescents in the urban and rural schools in Chhattisgarh, India. Materials and Methods: A cross-sectional study was conducted among 12 and 15-year-old and urban and rural school going children in Durg District. Scientifically, based on the data obtained from the pilot study, sample size was calculated. A total of 1000 children were selected to be a part of the study and were interviewed face-to-face using a detailed pretested, close-ended questionnaire. The Statistical Package for the Social Sciences version 16.0 (SPSS Pvt. Ltd, Chicago, IL, USA) was used for the statistical analyses. Results: Prevalence of tobacco consumption was 48.8%. Males were involved predominantly in consuming tobacco. The knowledge and attitude was better in the school children of urban areas than the school children of rural areas; more of the urban school children were involved in smoking cigarette. Rural children outnumbered urban children in the smokeless tobacco consumption. Conclusion: Prevalence of tobacco consumption among school children remains high with a wide disparity among urban and rural children. There is an urgent need to have a rural orientation in the National Tobacco Control Program that is currently being developed by the Government of India and giving relevance to the youth.
Keywords: Adolescence, adolescent, oral cancer, tobacco cessation, tobacco control
|How to cite this article:|
Sabnis R, Sahu K, Thakur D, Surana S, Mazhar H, Pandey S. Urban and rural disparity in tobacco use and knowledge about oral cancer among adolescents: An epidemiological survey on 12 and 15-year school going students. J Int Soc Prevent Communit Dent 2016;6, Suppl S3:226-31
|How to cite this URL:|
Sabnis R, Sahu K, Thakur D, Surana S, Mazhar H, Pandey S. Urban and rural disparity in tobacco use and knowledge about oral cancer among adolescents: An epidemiological survey on 12 and 15-year school going students. J Int Soc Prevent Communit Dent [serial online] 2016 [cited 2019 Oct 16];6, Suppl S3:226-31. Available from: http://www.jispcd.org/text.asp?2016/6/9/226/197200
| Introduction|| |
With the advent of the 21 st century, India has become one of the countries that is most affected by tobacco-related mortality.  A strange irony is that tobacco still exists as an easy, accessible, and legally available addictive substance and is a major contributor to mortality and morbidity, as well as a high contributor for chronic diseases and almost all kinds of cancers found in humans.  Approximately 1 in 10 in the age group 13-15 year has consumed tobacco, and out of these almost half reported initiation before 10 years of age.  Initiation of tobacco use is rooted midst the adolescence, with above 80% of adult smokers starting to smoke before attaining the age of 18 years; additionally, adolescents consuming smokeless tobacco are expected to grow into adult cigarette smokers than do the nonusers. , India ranks second in the production and the third in consumption of tobacco, and the prevalence is still rising, posing serious threat to public health. 
In contempt of the reinforced laws and regulations as per the COTPA-2003, there are children who are continuously exposed to the tobacco menace.  Various studies have been conducted about tobacco consumption among adolescents, , however, the literature appears to be very less with regard to comparison of tobacco usage among 12 and 15-year-old adolescents in the urban and rural schools in India. Therefore, this study had the following aims (1) Assessing and comparing the prevalence of tobacco use; (2) comparing knowledge and attitudes related to tobacco use and its health impact among urban and rural students; (3) disparity in tobacco use in urban and rural areas among 12 and 15-year-old adolescents in the urban and rural schools in Chhattisgarh, India.
| Materials And Methods|| |
Source of data and study population
The target population consisted of all 12-15-year-old school going children in Durg district. The Durg district consists of two Municipal Corporations (urban area) and 70 Gram Panchayats (rural area).
Sample size determination and sampling procedure
A total of 50 school children participated in the pilot study, which was carried out among 15-year-old school children from a private school of Durg Municipal Corporation (Urban area) to determine the feasibility of the study.
The sample size was determined by fixing the probability of committing type I error (α) at 5% and that of type II error (β) at 20%, thus maintaining the power of the study at 80%. The sample size was calculated using the Cochrane formula, which yielded a sample size of 508.
The same number (500) participants were selected from both the urban and rural areas, making the sample size to be 1000.
Before the commencement of this study, the synopsis was presented before the institutional ethical committee of Rungta College of Dental Sciences and Research, Bhilai. Important suggestions were then included in the present study as per the instructions of the members.
Both verbal and written informed consent was obtained from the participants and parents of the participants before their participation in the research. The parents who refused to give consent, their child/ward was abstained from the research.
The examinations were carried out on all the weekdays excluding the second Saturdays, Sundays, and holidays. The entire survey period spanned over a period of 4 months from November 2015 to February 2016.
A pretested, close-ended questionnaire was prepared for the interview keeping in mind the level of understanding of the children. The questionnaire was prepared covering the sociodemographic details, knowledge, and attitude toward tobacco usage and its health impact.
For the construction of questionnaire a panel of experts was selected who were trained in researches pertaining to tobacco and its oral impact and who were well versed in both English and Hindi languages. The questionnaire constructed was then sent to a peer expert committee for checking its content and face validity. After which necessary corrections and modifications were done and was made ready to use in the research.
Personal interviewing method was employed which used a pretested series of questions.
For the statistical analysis of the data, the Statistical Package for the Social Sciences version 16.0 (SPSS Pvt. Ltd, Chicago, IL, USA) was employed. Frequency distribution and Chi-square tests at 95% confidence interval were also calculated for analyzing the results. P value less than 0.05 was considered to be statistically significant.
| Results|| |
Baseline characters [Table 1]
[Table 1] depicts the baseline and demographic characteristics of the sample population. The total sample size constituted of 1000 school going children of 12 and 15-year age group. The male-to-female ratio was approximately 1:1.
Prevalence of tobacco use [Table 2]
The prevalence of tobacco consumption was found to be 48.8% (n = 488). According to the age group [Figure 1], in the sample population, majority of the 15-year-old school children (61.20%) were involved in consuming tobacco when compared to the 12-year-old (39.32%); the difference was found to be statistically significant. When assessed for the prevalence according to the sex [Figure 1], the males were indulged predominantly in consumption of tobacco (62.84%) than the girls (34.51%); the difference was found to be statistically significant.
The tobacco consumption was done in mainly two forms, i.e., either smoked or smokeless; 29.4% (n = 294) were indulged in smoking, 28.3% (n = 283) in using smokeless or chewable forms, and 8.9% (n = 89) were consuming both the forms of tobacco. The irony was that in consumption of any of the abovementioned forms of tobacco males were significantly involved in outrageous numbers the girls [Figure 2].
Knowledge and attitudes related to tobacco use and its health impact: Urban v/s rural [Table 3]
Smoking is harmful to health was agreed by a majority of the students. Sale of tobacco products to minors is prohibited in India; this fact was assessed by a question and urban students had more knowledge in this regard. A total of 83.2% of urban students responded that tobacco chewing can cause oral cancer. The fatality and mortality which could be caused due to oral cancer was known to 53.6% of urban students and 33.4% of rural students. The harmful effect of passive smoking was also assessed, and it was seen that 66% of the urban students and 46% of rural students agreed to this fact.
|Table 3: Descriptive statistics for knowledge and attitudes related to tobacco use and its health impact |
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For the question, do you think people who use tobacco have more friends?, 18.6% of the rural students responded "yes." An inclination towards smoking was seen in urban students. A total of 70.6% of the rural students responded "yes" while only 7% of the urban students agreed that they wish to consume guthka/pan masala after seeing any related advertisements. A total of 79.2% of the urban students responded affirmatively whereas 89.6% rural students rejected that they wish to smoke after seeing any sportsman or film actor smoking. A myth that occasional use of tobacco is harmful was judged by asking a question, to which shockingly 65% of the rural students said "no." The overall knowledge and attitude was better in the urban school children than the rural school children.
Urban v/s rural disparity in tobacco use [Table 4]
There was a highly statistically significant difference between the urban and rural school children in consumption of tobacco. Out of the 318 boys consuming tobacco, 219 were from the rural schools and 99 from the urban schools; further, out of the 170 girls who indulged in tobacco use 114 were from rural schools and 56 from urban schools [Figure 3], the difference was found to be highly statistically significant. For the smoked form, more of the urban school children (n = 89) were involved in smoking cigarette than do the rural school children (n = 62); the difference was statistically significant. However, when compared with smoking bidi, 142 rural school children were indulged in contrast to only 1 urban school child; the difference was highly statistically significant. There was a highly statistically significant difference in the consumption of smokeless form of tobacco among the urban and rural school children [Figure 4].
| Discussion|| |
There are various reports regarding tobacco consumption from different parts of India, i.e., 1.9% in New Delhi to 75% in Mizoram;  the total prevalence of tobacco consumption in the present study was found to be 48.8% [Table 1], this finding is significantly higher than the reports of Global Youth Tobacco Survey (GYTS) 2009 (14.6%),  2006 (13.7%),  and 2003 (16.9%).  Boys (62.84%) were predominantly involved in consumption of tobacco than girls (34.41%); similar findings were reported by Patna and Gupta,  as 57% boys and 41% of the girls were current tobacco users; however, the rates were significantly more when compared to the reports of GYTS 2009:  boys (19.0%) and girls (8.3%).
29.4% (n = 294) of the school going children were indulged in using smoked tobacco; this finding is considerably higher than the GYTS 2006 and GYTS 2009.  The smokeless or chewed form of tobacco was consumed by 28.3% children, which is much more than that reported by GYTS 2006 and 2009  and Jayakumary et al.  There was a statistically significant association between gender and smokeless tobacco use (P < 0.001) [Table 2], which may be attributed to the easy and cheap availability of the smokeless tobacco products in the markets.  The findings are corroborated by the other Indian studies. ,, The increase in consumption of these smokeless tobacco products is due to injudicious publicity and availability. 
The fact that tobacco is a risk factor for oral cancer was known to 83.2% urban students in contrast to 63% of the rural students. The fact that oral cancer can be fatal was agreed only by 53.6% of the urban and 33.4% of the rural school children; these findings are corroborated by the reports of Mukherjee et al.  and Mangalath et al. 
A total of 155 urban school children in contrast to 333 rural school children consumed tobacco, and the difference was found to be statistically significant (P < 0.001) [Table 4]. This finding matches with that of the report by Stevens et al. 
More rural school children were involved in tobacco consumption than urban school children; this finding matches with the reports of Stevens et al.  Significant difference (P < 0.001) exists among smokers in the rural and urban school children, with the former outnumbering the latter by large numbers findings and matching with the reports of Harrell et al.  The rural school children essentially and largely indulged in smokeless tobacco consumption than the urban children, and this disparity was also found to be statistically significant (P < 0.001) [Table 4]; this finding is similar to the reports of Stevens et al.  and Shah and El Haddad. 
The imbedded underlying recommendations which can be extracted are:
Requirement of child-based tobacco cessation counseling and health education, implementing COTPA stringently, and protection of the future of the country from the evil of Tobacco. There are limitations in the present study just like any population-based survey such as of social desirability associated with responding to a questionnaire, which can be managed by the use of a qualitative open-ended instrument.
Humans have used tobacco in many forms for several centuries.  There is a clear cut difference in tobacco use prevalence in school going children among those living in rural versus urban areas. A higher use of tobacco in rural adolescents will gradually lead to a higher number of people with health problems, which the rural areas are ill equipped to handle. Because tobacco use is one of the preventable causes of morbidity and mortality, efforts should be made to control tobacco use among the adolescents.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4]
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