Abstract
Background: Prevalence of smokeless tobacco (ST) consumption has been observed worldwide in the twentieth century, especially in Asian and African countries, with estimated 47% ST consumers in Pakistan. Therefore, the present study aimed to investigate the potential rationale of individuals for ST-initiation and various behavioural and psychological attributes of ST-consumers.
 Methodology: The study was conducted in an underprivileged area of Surjani town, West district of Karachi, Pakistan. 150 study participants were selected for the study, in which consumers of the current ST consumers (Betel nuts, Gutka and Oral Snuff) were recruited. In contrast, the individuals not taking ST served as controls. Individuals with smoking, any other type of addiction, medications for any chronic disease (hypertension, diabetes), or having any other behavioural/psychological problems were excluded from the study. A structured questionnaire was designed to evaluate the level of stress (Modified Hassles scale), addiction, and nicotine dependence. The participants were explained about the purpose of the study and the interviews were conducted by personal meet-up in their homes. Data was collected and analyzed via SPSS version 16.0.
 Results: Curiosity and peer pressure appeared to be among the most important factors for ST consumption initiation. 25% of ST consumers were found to be at the end stage of addiction, while 36% categorized to be in the second stage of addiction. Irritation, Anger, Headache and laziness were among the most prevalent types of feelings experienced by the study participants. The reduced stress levels in ST consumers compared to the controls were due to their euphoric condition attributed to the ST. Approximately 30% of the consumers were categorized to have an increased risk of obesity.
 Conclusion: As a readily available and affordable addictive agent, smokeless tobacco consumption has been raised in Pakistan more than in the west. Smokeless tobacco consumption-initiation has been linked to increased curiosity and peer pressure.
Highlights
The prevalence of smokeless tobacco (ST) consumption has been observed worldwide in the twentieth century, especially in Asian and African countries
The study was conducted in an underprivileged area of Surjani town, West district of Karachi, Pakistan. 150 study participants were selected for the study, in which consumers of the current ST consumers (Betel nuts, Gutka and Oral Snuff) were recruited
Curiosity and peer pressure appeared to be among the most important factors for ST consumption initiation. 25% of ST consumers were found to be at the end stage of addiction, while 36% categorized to be in the second stage of addiction
Summary
Prevalence of smokeless tobacco (ST) consumption has been observed worldwide in the twentieth century, especially in Asian and African countries, with estimated 47% ST consumers in Pakistan. The present study aimed to investigate the potential rationale of individuals for ST-initiation and various behavioural and psychological attributes of ST-consumers. Individuals with smoking, any other type of addiction, medications for any chronic disease (hypertension, diabetes), or having any other behavioural/psychological problems were excluded from the study. Results: Curiosity and peer pressure appeared to be among the most important factors for ST consumption initiation. Conclusion: As a readily available and affordable addictive agent, smokeless tobacco consumption has been raised in Pakistan more than in the west. Smokeless tobacco consumption-initiation has been linked to increased curiosity and peer pressure.
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