Abstract
BackgroundWith 600 million people using betel quid (BQ) globally, and smokeless tobacco (SLT) use being more wide-spread; the duo is an uphill public health concern in South Asian countries. SLT and/or BQ use increases the risk for morbidity and mortality from oral cancer. Because SLT and/or BQ use is initiated during adolescence, it renders this group more vulnerable; and particular attention is needed to curb SLT and/or BQ use to reduce related disease burden. We aimed to observe the differential individual, social and environmental features amongst SLT and/or BQ users to determine the key influencers of its use in adolescents.MethodsThis study was a cross-sectional survey of 2140 adolescents from secondary schools of Karachi, Pakistan. The main outcome measure was SLT and/or BQ use based on their consumption in the past 30 days. Univariate and multivariate regression binary logistic analyses were employed while reporting results in both crude form and adjusted odds ratio (after adjusting for all remaining individual, social and environmental level variables) with 95% confidence level. A p-value of < .05 was considered significant for all analyses.ResultsThe overall prevalence of SLT and/or BQ use was 42.6% (n = 912) of the total sample. The SLT and/or BQ consumer group had more males than females. A significant proportion of user (n = 558, 61.2%) was found in co-education schools. Students whose peers (OR = 6.79, 95% CI 4.67–9.87, p-value <0.001) and/or either of the parents (OR = 2.16, 95% CI 1.73–2.65, p-value <0.001) used SLT and/or BQ, alongside, adolescents who had not attended knowledge based sessions in schools regarding harmful effects of SLT and/or BQ were more likely to consume it. It’s availability with outside school hawkers increased the odds of its use by 6 times, as indicated by both univariate and multivariate models after adjusting for the remaining variables.ConclusionIn conclusion, students studying in co-education, parents and peers use, lack of knowledge based sessions on harmful health effects of SLT and/or BQ, and easy availability of the product from hawkers outside school all contribute towards enhanced risk of SLT and/or BQ use in adolescents.
Highlights
With 600 million people using betel quid (BQ) globally, and smokeless tobacco (SLT) use being more wide-spread; the duo is an uphill public health concern in South Asian countries
Aim Our purpose of the study was to observe the differential individual, social and environmental features amongst smokeless tobacco and/or Betel quid (SLT and/or BQ) users to determine the key influencers of its use in school going adolescents of Karachi
Individual, social and environmental characteristics of adolescents associated with the SLT and/or BQ use Individual based characteristics An overall 30 days prevalence of SLT and/or BQ use was estimated to be 42.6% (n = 912) of the total sample whereas 57.4% (n = 1228) participants did not use it in past 30 days
Summary
With 600 million people using betel quid (BQ) globally, and smokeless tobacco (SLT) use being more wide-spread; the duo is an uphill public health concern in South Asian countries. Nearly 6 million lives are lost due to tobacco consumption which is anticipated to rise exponentially and may hit 8 million by the year 2030 with its major burden in third world countries [2] This will render tobacco as the major cause of deaths worldwide. With 600 million people using betel quid (BQ) globally [4], and smokeless tobacco (SLT) use being more widely spread than ever [5]; the deadly combination is a constant uphill public health concern specially in South Asian countries in terms of increased morbidity and mortality from oral cancer [6]. SLT contains nicotine and carcinogenic nitrosamines which cause more than a quarter million deaths mainly due to oral and pharyngeal cancers [3, 5]
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